Aim: To determine as to whether chorionicity and zygosity were associated with PE in to explore any potential association of zygosity and PE . . Uncomplicated monochorionic diamniotic twins and the timing of delivery. There is also an association with neonatal intensive care unit Zygosity Versus Chorionicity and Amnionicity (chorion). This is monochorionic-diamniotic. Monochorionic twins are monozygotic (identical) twins that share the same placenta. If the placenta is shared by more than two twins (see multiple birth), these are monochorionic multiples. Monochorionic twins occur in % of all pregnancies. 75% of monozygotic twin pregnancies are monochorionic; the remaining Monochorionic-Diamniotic twins are almost always.
In the polyuric recipient, there is a large bladder and polyhydramnios left and the anuric donor is held fixed to the placenta by the collapsed membranes of the anhydramniotic sac right The precise underlying mechanism by which a select population of those mono chorionic pregnancies with vascular communications go on to develop twin-to-twin transfusion syndrome is not fully understood.
However, it has been hypothesized that primary maldevelopment of the placenta of the donor twin may cause increased peripheral resistance in the placental circulation which promotes shunting of blood to the recipient; the donor therefore suffers from both hypovolemia due to blood loss and hypoxia due to placental insufficiency30, The recipient fetus compensates for its expanded blood volume with polyuria32, but, since protein and cellular components remain in its circulation, the consequent increase in colloid oncotic pressure draws water from the maternal compartment across the placenta.
A vicious cycle of hyper volemia, polyuria and hyperosmolality is established, leading to high-output heart failure and polyhydramnios. These observations were made in live births and therefore the criteria may only apply to relatively mild twin-to-twin transfusion syndrome, since severe cases result in mis carriage or stillbirth.
Monochorionic twins - Wikipedia
Severe disease, with the development of polyhydramnios, becomes apparent at 16—24 weeks of pregnancy. Other sonographic findings that may prove to be of prognostic significance include the presence of a hypertrophic, dilated and dyskinetic heart, with absence or reversal of flow in the ductus venosus during atrial contraction In the donor, the heart may be dilated, the bowel is hyperechogenic, and there is absent end-diastolic flow in the umbilical artery; these features are commonly seen in hypoxemic fetuses in pregnancies with severe uteroplacental insufficiency.
Early prediction of twin-to-twin transfusion syndrome Ultrasonographic features of the underlying hemodynamic changes in severe twin-to-twin transfusion syndrome may be present from as early as 11—14 weeks of gestation and manifest as increased nuchal translucency thickness in one or both of the fetuses.
In a study of monochorionic twin pregnancies, including 16 that developed severe twin-to-twin transfusion syndrome at 15—22 weeks of gestation, increased nuchal translucency above the 95th centile of the normal range at the 11—week scan was associated with a four-fold increase in risk for the subsequent development of severe twin-to-twin transfusion syndrome Figure 10 Intertwin discrepancies in crown—rump length were not predictive of subsequent development of twin-to-twin transfusion syndrome.
It is possible that increased nuchal translucency thickness in the recipient fetus may be a manifestation of heart failure due to hypervolemic congestion. With advancing gestation and the development of diuresis that would tend to correct the hypervolemia and reduce heart strain, both the congestive heart failure and nuchal translucency resolve.
Figure 10 - In monochorionic twin pregnancies at the 11—week scan, increased nuchal translucency NT thickness in one or both fetuses is associated with a four-fold increase in risk for the subsequent development of severe twin-to-twin transfusion syndrome Roumen Kirov Peer reviewer comments 2 Editor who approved publication: Relatively little is known about the neurodevelopmental and behavioral outcomes of monochorionic diamniotic MCDA twin pregnancies where there are no antenatal complications peculiar to monochorionicity or prematurity.
Twenty-two MCDA twins 44 children with an average age of 4. Parents completed a battery of neurodevelopmental and behavioral assessment questionnaires. MCDA twins delivered in the third trimester with no antenatal monochorionic complications in the first two trimesters appear to be at risk for subtle neurodevelopmental difficulties, associated with a lower birth weight.
Ongoing developmental surveillance of these children during preschool-age is indicated for early identification and intervention. In monochorionic MC multiples, the perinatal morbidity and mortality risk is significantly higher than dichorionic DC twins, which are the commonest type of twins.
MC diamniotic MCDA twins are identical twins who share a placenta but not an amniotic sac, with this architecture arising in around two-thirds of monozygotic twins, 145 or around one in of all pregnancies.
MCDA pregnancies are associated with three to six times increased risk of complications compared to DC twins, where each fetus has its own placenta. In addition, severe discordant congenital anomalies occur more frequently in MCDA pregnancies and are associated with an increased risk of morbidity and mortality. The authors reported that the majority of 2-year-old twins had normal developmental status, and that there were no significant differences between MC and DC twins, apart from a slight delay in hearing and language development in MC twins.
Birth weight discordancy did not appear to influence long-term outcome, although there was a trend toward lower Griffith Developmental Quotient DQ scores in the smaller twin than in its larger co-twin. There was, however, a significant difference in development between boys and girls, whereby boys had lower DQ scores and the proportion of mildly delayed development was higher amongst male infants.
The study showed that across both the MC and DC groups, the largest proportion of identified developmental concerns on the Griffith scales was within the locomotor domain ie, The authors noted that follow-up at an older child age would be preferable as difficulties relating to neurological handicaps and intellectual disability may only become evident at that time. It is also difficult to ascertain factors influencing uncomplicated MCDA twins specifically, given the mixed cohorts which have included the full range of complications including TTTS, co-twin death, and premature birth.
Critically, studies have tended to focus on mortality and core neurodevelopmental status, while not exploring the impacts upon socio-emotional and behavioral development. Thus, there do not appear to be any studies available where the effects of uncomplicated MCDA pregnancy on long-term neurodevelopmental outcome are examined. Further, the literature suggests that MCDA pregnancies that appear uncomplicated using standard screening procedures may indeed carry significant undetected complications, sometimes leading to fetal death.
Liverpool Hospital is a tertiary referral center in the South Western Sydney Local Health District, which covers a total of seven local government areas and an estimated population ofThe study used both retrospective and prospective methodology.
Retrospective data were extracted from the existing FMU database in the form of an initial patient list, by selecting for MCDA pregnancies that were uncomplicated and undelivered before 28 weeks between the 1st of January and 31st of December Prospective data were collected in the form of three parent-completed questionnaires that were sent and received by mail.
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Of the remaining 70 cases, eight were listed as requiring an interpreter and were excluded from the final list due to the unavailability of an interpreter to the study due to resourcing, leaving 62 eligible cases. A further 16 of these cases were uncontactable, leaving a final pool of 46 eligible cases. Consent to participate in the study was obtained via an initial phone call in 44 cases, with two patients declining to participate.
Study packs, which included a study information and consent form for patients to sign, were sent to these 44, and follow-up phone calls were made if packs were not returned within 3 weeks. These included gestational age at birth, birth weight and estimated fetal weight and their percentiles, mode of delivery, Apgar scores, and ultrasound Doppler studies.
Chorionicity was determined by ultrasound in accordance with accepted criteria. Pregnancies complicated by major congenital malformations, aneuploidy, and the intrauterine demise of a co-twin were also excluded.
The week scan - Chapter
The CDC 24 was scored by calculating the DQ that is, of the child in the domains of social, self-help, gross motor, fine motor, and language, as well as an overall DQ, which was calculated as the average of the five domain scores. There is a long history of research supporting the accuracy of parent self-report of child development when using structured inventories. In light of the small sample size recruited for this study, a predominantly descriptive approach was taken to the data analysis.
Independent t-tests were used in a broad comparison of all developmental and behavioral problems with birth weight and gestational age. Results Of the 22 pairs of twins included in the study, the mean age was 4. The cohort was split evenly by sex, with 11 male and 11 female twin pairs.
Additional baseline family data of these pairs are summarized in Table 1. Table 1 Family data Abbreviation: Pregnancy outcome All 22 pregnancies resulted in live births. Twenty-four of the deliveries were by elective cesarean section In two cases, an emergency cesarean section was performed following the vaginal birth of the first twin due to birth complications placental abruption and uncorrectable malpresentation.
Mean gestational age was 35 weeks and 5 days, with a range from 29 to 38 weeks. The distribution of gestational ages was relatively normal with no evidence of bimodality: Mean birth weight was 2, g, and three sets of twins presented with significant birth weight discordances of As these three sets of twins were not identified using the antenatal screening methodology employed in the study, they were retained in the sample.
The mean maternal age was Preeclampsia was diagnosed in one primiparous pregnancy, resulting in an overall prevalence of 4. Table 2 Pregnancy outcomes for children in the study Note: Developmental and behavioral outcomes Developmental and behavioral data in the form of the parent survey and CBCL were received for all the children. In addition, other medical issues were reported as follows: Details of diagnosis, severity, and treatment were not provided by parents. Table 3 Profile of children showing abnormal developmental outcomes Note: Use of the same letters in the twin pair column denotes a twin data set; only one set of data is presented in the case of some twin pairs where one of the twins was developing normally.
CBCL results are presented in Table 4 and are organized according to normal, borderline, and clinical categories. The average frequency of normal scores in the six CBCL baseline categories per child was