Article

Gestational age at delivery and perinatal outcomes in twin gestations

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama School of Medicine, Birmingham, AL.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 08/2012; 207(5). DOI: 10.1016/j.ajog.2012.08.012
Source: PubMed

ABSTRACT OBJECTIVE: The optimal gestational duration for twin gestations is unknown. Epidemiologic studies show that the lowest perinatal mortality rate for twins is at 37-38 weeks, but these studies lack information on pregnancy complications and neonatal morbidities. This study evaluates pregnancy characteristics and perinatal outcomes of twins in order to assess the optimal gestational age for delivery. STUDY DESIGN: This is a retrospective study of twins delivered at ≥36 weeks at our institution from 1991-2009. The composite rate of perinatal morbidity and mortality (including perinatal death, respiratory distress, suspected sepsis, and need for neonatal intensive care) was determined for weekly intervals from 36-39(+) weeks. RESULTS: There were 377 twin gestations included. Of those 83% were dichorionic. Fifty-three percent had spontaneous labor and 48% were delivered by cesarean section. Perinatal outcomes improved as gestational age advanced to 38 weeks. CONCLUSION: Perinatal morbidity and mortality rates suggest that the optimal time for delivery of twins is at 38 weeks or greater.

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    ABSTRACT: Abstract Objective: To assess the perinatal outcome in twin pregnancies according to chorionicity. Methods: This was a retrospective cohort study of twin pregnancies from January 2001 to December 2012. Maternal and perinatal outcomes of monochorionic (MC) and dichorionic (DC) twins were compared by using chi-square and t-test. Perinatal complications were compared by adjusted odds ratio using logistic regression at 5% level of significance. Results: Among 391 twin pregnancies, 116 ( 29.6%) were MC and 275 (72.95%) were DC. In MC twins, the rate of miscarriage was three fold higher than DC (12.6% vs 4.4% )p-value < 0.000 ) Mean birth weight in DC was 218.4 grams higher than the MC (p-value <0.000). Similarly, MC twins were 1.92 times [CI (1.02-3.62), p-value=0.042] more likely to be delivered preterm. Likewise, neonatal intensive care admission for MC was 2.23 times [CI ( 1.08-4.06), p-value = 0.03], congenital anomalies were 4.75 times [CI (1.22-18.4 p-value=0.024] Fetal growth restriction was 1.86 times more common in the MC twin pair. [CI 1.07-3.21] P value =0.026 Conclusions: Monochorionic twins were more at risk for adverse outcomes than dichorionic twins. Determining chorionicity at early pregnancy will help the Obstetricians to plan the care of these patients. This will help not only in managing twin pregnancies but also help in counseling according to the local perinatal outcome.
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