Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: A multicentre retrospective cohort study

K. E A Hack, J. B. Derks, S. G. Elias, F. A. Van Mameren, C. Koopman-Esseboom, B. W J Mol, E. Lopriore, A. H P Schaap, B. Arabin, J. J. Duvekot, A. T J I Go, E. Wieselmann, A. J. Eggink, C. Willekes, F. P H A Vandenbussche, G. H A Visser

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery. Design Multicentre retrospective cohort study. Setting Ten perinatal referral centres in the Netherlands. Population All MC twin pregnancies without TTTS delivered at ≥32 weeks of gestation between January 2000 and December 2005. Methods The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed. Main outcome measures Perinatal mortality in relation to gestational age and mode of delivery at ≥32 weeks of gestation. Results After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants). In women who delivered ≥37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77%. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome. Conclusions In MC twin pregnancies the incidence of intrauterine fetal death is low ≥32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.

LanguageEnglish
Pages1090-1097
Number of pages8
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume118
Issue number9
DOIs
Publication statusPublished - 1 Aug 2011

Keywords

  • Female preponderance in twins
  • mode of delivery
  • monochorionic
  • optimal time of delivery
  • perinatal mortality
  • pregnancy
  • twin

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Hack, K. E A ; Derks, J. B. ; Elias, S. G. ; Van Mameren, F. A. ; Koopman-Esseboom, C. ; Mol, B. W J ; Lopriore, E. ; Schaap, A. H P ; Arabin, B. ; Duvekot, J. J. ; Go, A. T J I ; Wieselmann, E. ; Eggink, A. J. ; Willekes, C. ; Vandenbussche, F. P H A ; Visser, G. H A. / Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation : A multicentre retrospective cohort study. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2011 ; Vol. 118, No. 9. pp. 1090-1097.
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title = "Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: A multicentre retrospective cohort study",
abstract = "Objective To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery. Design Multicentre retrospective cohort study. Setting Ten perinatal referral centres in the Netherlands. Population All MC twin pregnancies without TTTS delivered at ≥32 weeks of gestation between January 2000 and December 2005. Methods The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed. Main outcome measures Perinatal mortality in relation to gestational age and mode of delivery at ≥32 weeks of gestation. Results After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants). In women who delivered ≥37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77{\%}. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome. Conclusions In MC twin pregnancies the incidence of intrauterine fetal death is low ≥32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.",
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author = "Hack, {K. E A} and Derks, {J. B.} and Elias, {S. G.} and {Van Mameren}, {F. A.} and C. Koopman-Esseboom and Mol, {B. W J} and E. Lopriore and Schaap, {A. H P} and B. Arabin and Duvekot, {J. J.} and Go, {A. T J I} and E. Wieselmann and Eggink, {A. J.} and C. Willekes and Vandenbussche, {F. P H A} and Visser, {G. H A}",
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Hack, KEA, Derks, JB, Elias, SG, Van Mameren, FA, Koopman-Esseboom, C, Mol, BWJ, Lopriore, E, Schaap, AHP, Arabin, B, Duvekot, JJ, Go, ATJI, Wieselmann, E, Eggink, AJ, Willekes, C, Vandenbussche, FPHA & Visser, GHA 2011, 'Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: A multicentre retrospective cohort study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 118, no. 9, pp. 1090-1097. https://doi.org/10.1111/j.1471-0528.2011.02955.x

Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation : A multicentre retrospective cohort study. / Hack, K. E A; Derks, J. B.; Elias, S. G.; Van Mameren, F. A.; Koopman-Esseboom, C.; Mol, B. W J; Lopriore, E.; Schaap, A. H P; Arabin, B.; Duvekot, J. J.; Go, A. T J I; Wieselmann, E.; Eggink, A. J.; Willekes, C.; Vandenbussche, F. P H A; Visser, G. H A.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 118, No. 9, 01.08.2011, p. 1090-1097.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

AU - Hack, K. E A

AU - Derks, J. B.

AU - Elias, S. G.

AU - Van Mameren, F. A.

AU - Koopman-Esseboom, C.

AU - Mol, B. W J

AU - Lopriore, E.

AU - Schaap, A. H P

AU - Arabin, B.

AU - Duvekot, J. J.

AU - Go, A. T J I

AU - Wieselmann, E.

AU - Eggink, A. J.

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AU - Vandenbussche, F. P H A

AU - Visser, G. H A

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N2 - Objective To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery. Design Multicentre retrospective cohort study. Setting Ten perinatal referral centres in the Netherlands. Population All MC twin pregnancies without TTTS delivered at ≥32 weeks of gestation between January 2000 and December 2005. Methods The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed. Main outcome measures Perinatal mortality in relation to gestational age and mode of delivery at ≥32 weeks of gestation. Results After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants). In women who delivered ≥37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77%. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome. Conclusions In MC twin pregnancies the incidence of intrauterine fetal death is low ≥32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.

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KW - Female preponderance in twins

KW - mode of delivery

KW - monochorionic

KW - optimal time of delivery

KW - perinatal mortality

KW - pregnancy

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