| Contributors: |
Saccone G1, Khalil A2,3, Thilaganathan B2,3, Glinianaia SV4, Berghella V5, D'Antonio F6; MONOMONO, NorSTAMP and STORK research collaboratives. Zullo F, Locci M, Guida M, Anastasio H, Ghi T, Frusca T, Dall'Asta A, Galli L, Volpe N, Lanna M, Faiola S, Fichera A, Prefumo F, Rizzo G, Arduino S, Cantanna E, Simonazzi G, Seravalli V, Rita Magro-Malosso E, Di Tommaso M, L Miller J, A Baschat A, Vitagliano A, Visentin S, Cosmi E, Caissutti C, Driul L, Di Mascio D, Benedetti Panici P, Vena F, Brunelli R, Ciardulli A, Schoen C, Suhag A, Maria Gambacorti-Passerini Z, Angeles Anaya Baz M, Magoga G, Busato E, Filippi E, José Rodriguez Suárez M, Gamez Alderete F, Alonso Ortuno P, Vendola M, Navaneethan P, Wimalasundera R, Napolitano R, Mollo A, Imma Aquino C, D'Agostino S, Gallo C, Venturella R, Flacco M, Hannon T, N Sturgiss S, Rankin J, Miller N, Martin D, Bahamie A, Bhide A, Papageorghiou A, Deans A, Morgan K, Egbor M, Matiluko A, Ellis C, Gandhi H, Hamid R, Hutt R, Roberts L, Pakarian F, Peregrine E. |
| Description: |
OBJECTIVES: The primary objective was to quantify the risk of perinatal mortality in non-anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth-weight (BW) discordance. The secondary objectives were to investigate the effect of inpatient vs outpatient fetal monitoring on the risk of mortality in weight-discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality. METHODS: This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatient vs outpatient fetal monitoring with the risk of mortality in weight-discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver-operating-characteristics-curve analyses were used to analyze the data. RESULTS: The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1-4.4; P = 0.022) and increased up to an OR of 4.4 (95% CI, 1.3-14.4; P = 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW-discordance cut-offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver-operating-characteristics curve of 0.60 (95% CI, 0.46-0.73), 0.52 (95% CI, 0.33-0.72) and 0.57 (95% CI, 0.45-0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW-discordance cut-off. CONCLUSIONS: MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for . |