OBJECTIVES: To estimate the risk of stillbirth in dichorionic and monochorionic twins compared with singletons, and to evaluate the relevant causes of stillbirth in each group. STUDY DESIGN: A retrospective cohort analysis of all pregnancies ≥22 weeks of gestation was performed at a tertiary care center from January 1995 to June 2011. The overall fetal survival and the prospective risk of stillbirth were compared in monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins, and singletons. Causes of stillbirth were classified using the ReCoDe classification and were compared among the three study groups. RESULTS: A total of 46,200 singletons, 462 MCDA twins and 1108 DCDA twins were included in the study. Both Kaplan-Meier analysis and prospective risk calculation showed that MCDA twins had the highest risk of stillbirth (OR ranging between 13.5 95% CI 8.7-20.7 at 22.0-24.6 weeks and 4.0 95% CI 1.1-13.1 at 31.0-33.6 weeks, compared to singletons), while singletons had the lowest. Main causes of stillbirth were major congenital malformations in singletons (25.1%) and in DCDA twins (75%), and twin-twin transfusion syndrome in MCDA twins (81.5%). When excluding fetuses affected by major congenital anomalies, MCDA twins (p<0.001) but not DCDA twins (p=0.2) remained at increased risk for stillbirth compared with singletons. CONCLUSION: The risk of stillbirth is significantly higher both in MCDA and DCDA twins compared with singletons. Stillbirths are mainly due to twin-twin transfusion syndrome in MCDA twins and major congenital anomalies in DCDA twins. When major congenital anomalies are excluded, DCDA twins have a similar in utero mortality to singletons.
OBJECTIVES: To estimate the risk of stillbirth in dichorionic and monochorionic twins compared with singletons, and to evaluate the relevant causes of stillbirth in each group. STUDY DESIGN: A retrospective cohort analysis of all pregnancies ≥22 weeks of gestation was performed at a tertiary care center from January 1995 to June 2011. The overall fetal survival and the prospective risk of stillbirth were compared in monochorionic diamniotic (MCDA) twins, dichorionic diamniotic (DCDA) twins, and singletons. Causes of stillbirth were classified using the ReCoDe classification and were compared among the three study groups. RESULTS: A total of 46,200 singletons, 462 MCDA twins and 1108 DCDA twins were included in the study. Both Kaplan-Meier analysis and prospective risk calculation showed that MCDA twins had the highest risk of stillbirth (OR ranging between 13.5 95% CI 8.7-20.7 at 22.0-24.6 weeks and 4.0 95% CI 1.1-13.1 at 31.0-33.6 weeks, compared to singletons), while singletons had the lowest. Main causes of stillbirth were major congenital malformations in singletons (25.1%) and in DCDA twins (75%), and twin-twin transfusion syndrome in MCDA twins (81.5%). When excluding fetuses affected by major congenital anomalies, MCDA twins (p<0.001) but not DCDA twins (p=0.2) remained at increased risk for stillbirth compared with singletons. CONCLUSION: The risk of stillbirth is significantly higher both in MCDA and DCDA twins compared with singletons. Stillbirths are mainly due to twin-twin transfusion syndrome in MCDA twins and major congenital anomalies in DCDA twins. When major congenital anomalies are excluded, DCDA twins have a similar in utero mortality to singletons.
Authors: Fiona Cheong-See; Ewoud Schuit; David Arroyo-Manzano; Asma Khalil; Jon Barrett; K S Joseph; Elizabeth Asztalos; Karien Hack; Liesbeth Lewi; Arianne Lim; Sophie Liem; Jane E Norman; John Morrison; C Andrew Combs; Thomas J Garite; Kimberly Maurel; Vicente Serra; Alfredo Perales; Line Rode; Katharina Worda; Anwar Nassar; Mona Aboulghar; Dwight Rouse; Elizabeth Thom; Fionnuala Breathnach; Soichiro Nakayama; Francesca Maria Russo; Julian N Robinson; Jodie M Dodd; Roger B Newman; Sohinee Bhattacharya; Selphee Tang; Ben Willem J Mol; Javier Zamora; Basky Thilaganathan; Shakila Thangaratinam Journal: BMJ Date: 2016-09-06
Authors: Hyun Sun Ko; Sae Kyung Choi; Jeong Ha Wie; In Yang Park; Yong Gyu Park; Jong Chul Shin Journal: J Korean Med Sci Date: 2018-03-05 Impact factor: 2.153
Authors: Claudia Hanson; Stephen Munjanja; Agnes Binagwaho; Bellington Vwalika; Andrea B Pembe; Elsa Jacinto; George K Chilinda; Kateri B Donahoe; Sikolia Z Wanyonyi; Peter Waiswa; Muchabayiwa F Gidiri; Lenka Benova Journal: PLoS Med Date: 2019-02-19 Impact factor: 11.069
Authors: Jenny van Dongen; Scott D Gordon; Allan F McRae; Veronika V Odintsova; Hamdi Mbarek; Charles E Breeze; Karen Sugden; Sara Lundgren; Juan E Castillo-Fernandez; Eilis Hannon; Terrie E Moffitt; Fiona A Hagenbeek; Catharina E M van Beijsterveldt; Jouke Jan Hottenga; Pei-Chien Tsai; Josine L Min; Gibran Hemani; Erik A Ehli; Franziska Paul; Claudio D Stern; Bastiaan T Heijmans; P Eline Slagboom; Lucia Daxinger; Silvère M van der Maarel; Eco J C de Geus; Gonneke Willemsen; Grant W Montgomery; Bruno Reversade; Miina Ollikainen; Jaakko Kaprio; Tim D Spector; Jordana T Bell; Jonathan Mill; Avshalom Caspi; Nicholas G Martin; Dorret I Boomsma Journal: Nat Commun Date: 2021-09-28 Impact factor: 14.919