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- W2120954908 abstract "To assess the impact of placental chorionicity on the risk of stillbirth in twins. We retrospectively developed the Twin Pregnancy Perinatal Database (TPPD) in a tertiary university hospital for deliveries between January 1, 1991 and January 1, 2011. We recorded maternal demographics, pregnancy complications and pregnancy outcomes. Pregnancies affected by major anomalies, twin-twin transfusion syndrome, multiple fetal reduction and alloimmunization were excluded. The risk of fetal death with advancing gestation was calculated for “apparently normal” monochorionic-diamniotic (Mono/Di) twins and for dichorionic-diamniotic (Di/Di) twins. Overall in utero survival was analyzed using a time-to-event (Kaplan-Meier) analysis using week of gestation as the time scale. Intrauterine fetal demise (IUFD) per pregnancy was defined as the event, and all other births were censored. Survival for Mono/Di vs. Di/Di twins, were compared by the log-rank test. Hazard ratios and 95% confidence intervals were estimated using a Cox proportional hazards model and adjusted for covariates that differed at baseline. Of the 754 twin pregnancies in the TPPD, 106 (14.1%) were excluded, 121 (16.0%) were Mono/Di twins and 527 (70%) were Di/Di twins. Stillbirths occurred in 4 (3.3%) Mono/Di [25-1/7, 26-0/7, 28-6/7, 34-1/7 weeks] and 3 (0.6%) Di/Di twin pairs [27-0/7, 30-0/7, 34-2/7 weeks]. Mono/Di twins had a higher risk of stillbirth compared with Di/Di twins, (log-rank P=.007) (Figure A). After adjustment for maternal age at delivery, smoking, chronic hypertension and maternal DM, a Mono/Di twin pregnancy compared with a Di/Di twin pregnancy, is associated with 11.3 times higher risk of IUFD (HR=11.32, 1.15-111.59). Monochorionicity has a negative effect on the in-utero survival of twins, even among apparently normal monochorionic-diamniotic twins. In the absence of a clinical indication for delivery, these data do not support elective late preterm [34-36 weeks] delivery for prevention of intrauterine fetal demise in “apparently normal” Mono/Di twins." @default.
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- W2120954908 date "2012-01-01" @default.
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- W2120954908 title "89: Twin chorionicity and the risk of stillbirth" @default.
- W2120954908 doi "https://doi.org/10.1016/j.ajog.2011.10.107" @default.
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