Obstetric outcome in twin gestation with reference to chorionicity

Authors

  • Lekshmi Murukesan Department of Obstetrics and Gynecology, Sree Gokulam Medical College, Thiruvananthapuram, Kerala, India
  • Mayadevi Brahmanandan Department of Obstetrics and Gynecology, Government Medical College, Thiruvananthapuram, Kerala, India
  • Sujamol Sujamol Jacob Department of Obstetrics and Gynecology, Government Medical College, Thiruvananthapuram, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20174998

Keywords:

Dichorionic, Monochorionic, Pregnancy outcome, Perinatal outcome

Abstract

Background: Monochorionic twin pregnancies are at greater risk for growth abnormalities and other complications. This study aims to outline the obstetric problems faced by twins in general and also to determine the influence of chorionicity on pregnancy and perinatal outcome in twins. Objective of present study was to compare the obstetric and perinatal outcome between monochorionic and dichorionic twins.

Methods: A clinical non-interventional prospective observational study was conducted in a tertiary care hospital over a period of 1 year. 232cases of twin pregnancies were followed up from first trimester. The antepartum complications, mode of delivery, presentation, pregnancy outcome, condition of babies and perinatal mortality were compared between mono-chorionic and dichorionic twins.

Results: Among 232 cases of twins studied, 2/3rd were dichorionic and 1/3rd were monochorionic. The mean gestational age for Monochorionic (MC) twins was 33.2 weeks whereas it was 35.6 weeks for Dichorionic (DC) twins. Preterm delivery was significantly associated with mono-chorionicity. Elective CS was done more for MC twins compared to DC twins. The mean birth weight of MC twins was 1.7 kg compared to 2.1 kg among DC twins. Low APGAR scores were seen in 31.3% of MC twins compared to 15.8% of DC twins. The number of asphyxiated babies (12.5%), stillborn (7.5%) and macerated babies (10%) were more in MC group in comparison to DC group where it was (9.9%, 2.1%, 0.7%) respectively. Risk of IBN admissions were more in MC than DC twins. (31.3% Vs 21.1%) Adverse perinatal outcome was associated more with MC pregnancies (37.5%) than DC. (11.8%).

Conclusions: Mono-chorioncity was significantly associated with pregnancy complications and adverse perinatal outcome. Hence early diagnosis of chorionicity and referral to a tertiary centre with fetal medicine unit and newborn care is very important in reducing morbidity and perinatal mortality among MC twins.

Author Biography

Lekshmi Murukesan, Department of Obstetrics and Gynecology, Sree Gokulam Medical College, Thiruvananthapuram, Kerala, India

Associate Professor, Department of O&G, Sree Gokulam Medical College, Thiruvananthapuram

References

Blondel B, Kaminski M. Trends in the occurrence, determinants, and consequences of multiple births. InSeminars in perinatology. WB Saunders. 2002 Aug;26(4):239-249.

Norwitz ER, Edusa V, Park JS. Maternal physiology and complications of multiple pregnancy. InSeminars in perinatology. WB Saunders. 2005 Oct;29(5):338-348.

Ghai V, Vidyasagar D. Morbidity and mortality factors in twins. An epidemiologic approach. Clin Perinatol. 1988 Mar;15(1):123-40.

Gardner MO, Goldenberg RL, Cliver SP, Tucker JM, Nelson KG, Copper RL. The origin and outcome of preterm twin pregnancies. Obstet Gynecol. 1995 Apr 1;85(4):553-7.

Chitrit Y, Filidori M, Pons JC, Duyme M, Papiernik E. Perinatal mortality in twin pregnancies: a 3-year analysis in Seine Saint-Denis (France). European J Obstet Gynecol Reprod Biol. 1999 Sep;86(1):23-8.

Snijder MJ, Wladimiroff JW. Fetal biometry and outcome in monochorionic vs. dichorionic twin pregnancies; a retrospective cross-sectional matched-control study. Ultrasound Med Biol. 1998 Feb;24(2):197-201.

Victoria A, Mora G, Arias F. Perinatal outcome, placental pathology, and severity of discordance in monochorionic and dichorionic twins. Obstet Gynecol. 2001 Feb;97(2):310-5.

Chauhan SP, Shields D, Parker D, Sanderson M, Scardo JA, Magann EF. Detecting fetal growth restriction or discordant growth in twin gestations stratified by placental chorionicity. J Reprod Med. 2004 Apr;49(4):279-84.

Domingues AP, Gonçalves S, Vasco E, Fonseca E, Moura P. Chorionicity in twin pregnancies: impact upon perinatal results. Acta Obstet Ginecol Port. 2007;1(4):163-6.

Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH. The hidden mortality of monochorionic twin pregnancies. BJOG: An Int J Obstet Gynecol. 1997 Oct;104(10):1203-7.

Divon MY, Marin MJ, Pollack RN, Katz NT, Henderson C, Aboulafia Y et al. Twin gestation: fetal presentation as a function of gestational age. Am J Obstet Gynecol. 1993 May;168(5):1500-2.

Smits J, Monden C. Twinning across the developing world. PLoS One. 2011 Sep;6(9):e25239.

Hatkar PA, Bhide AG. Perinatal outcome of twins in relation to chorionicity. J Postgraduate Med. 1999 Apr;45(2):33.

Radhakrishnan R, Radhakrishnan R. Perinatal outcome of twin pregnancy and influence of chorionicity on it. Int J Prevent Therap Med. 2014 Mar;1(2).

Cheung YB, Yip P, Karlberg J. Mortality of twins and singletons by gestational age: a varying-coefficient approach. Am J Epidemiol. 2000 Dec;152(12):1107-16.

Radhakrishnan R, Radhakrishnan R. The perinatal outcome of first and second twin. Int J Prevent Therapeu Med. 2014 Jun 11;2(2).

Samra JS, Spillane H, Mukoyoko J, Tang L, Obhrai MS. Caesarean section for the birth of the second twin. BJOG: Int J Obstet Gynecol. 1990 Mar;97(3):234-6.

Guttmacher AF, Kohl SG. The fetus of multiple gestations. Obstet Gynecol. 1958 Nov;12(5):528-40.

Assunção RA, Liao AW, Brizot MD, Krebs VL, Zugaib M. Perinatal outcome of twin pregnancies delivered in a teaching hospital. Revista da Associação Médica Brasileira. 2010;56(4):447-51.

Bleker OP, Hemrika DJ. Gestational age according to fetal sex in twins. Am J Obstet Gynecol. 1985 Mar 15;151(6):830-1.

Naeye RL, Tafari N, Judge D, Marboe CC. Twins: causes of perinatal death in 12 United States cities and one African city. Am J Obstet Gynecol. 1978 Jun 1;131(3):267-72.

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Published

2017-10-28

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Original Research Articles