Hydramnios in Twin Gestations
ABSTRACT : To estimate the effect of hydramnios on pregnancy outcomes in dichorionic and monochorionic twins.
: This is a retrospective cohort study of women with twin pregnancies who underwent ultrasound evaluation between 1997 and 2010 and delivered liveborn neonates or stillborn fetuses at 24 weeks of gestation or more at a single institution. Hydramnios was defined as a single deepest pocket of amniotic fluid of at least 8 cm, and it was further categorized as mild (8-9.9 cm), moderate (10-11.9 cm), or severe (12 cm or more). The greatest degree of hydramnios identified during pregnancy was used for analysis. Monoamniotic pregnancies and pregnancies complicated by twin-twin transfusion syndrome were excluded. Anomalous neonates and stillborn fetuses were analyzed separately.
: Of 1,951 twin pregnancies, 1,311 were dichorionic (67%) and 640 were monochorionic (33%). Hydramnios was identified in 348 pregnancies (18%). Major anomalies were more common with increasing hydramnios in both dichorionic and monochorionic twins (P<.001), with anomaly prevalence nearly 20% in cases of severe hydramnios. Severe hydramnios was significantly associated with stillbirth in monochorionic gestations (3 of 11, 27%, P<.001). Hydramnios was not associated with preterm delivery, fetal growth restriction, neonatal intensive care unit admission, or neonatal death in either dichorionic or monochrorionic pregnancies.
: Hydramnios is common in twins, occurring in one of six dichorionic and monochorionic pregnancies. Anomaly prevalence increased with degree of hydramnios; in monochorionic gestations, severe hydramnios was associated with risk of stillbirth. Despite this, adverse outcomes do not appear to be more frequent in the setting of hydramnios in twin getstaions.
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ABSTRACT: The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the association of sonographic estimates of AFV with dye-determined AFV, and correlate AFV with antepartum, intrapartum, and perinatal outcomes in twin pregnancies. Studies were included if they were adequately powered and investigated antepartum, intrapartum, and/or perinatal adverse outcome parameters in twin gestations. Studies with comparable populations and exclusion criteria were merged into forest plots. Data comparing the accuracy of AFV assessment, correlation of AFV with gestational age, and adverse outcomes were tabulated. Five of the 6 studies investigating AFV by the amniotic fluid index as a function of gestational age reported data fitting a quadratic equation, with fluid volumes peaking at mid gestation and then declining. This trend was less pronounced when AFV was assessed by the single deepest pocket (2 of 4 studies reporting a quadratic fit). Polyhydramnios was associated with prematurity in 2 of 4 studies (1 amniotic fluid index and 1 single deepest pocket), and oligohydramnios was associated with prematurity in 1 single deepest pocket study. Stillbirth was the only intrapartum outcome reported in more than 1 study. Perinatal outcomes associated with polyhydramnios included neonatal death (P < .05 in 1 of 2 studies), low Apgar scores (1 of 2 studies), neonatal intensive care unit admission (1 of 2 studies), and low birth weight (2 of 3 studies).Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 08/2014; 33(8):1353-1364. DOI:10.7863/ultra.33.8.1353 · 1.53 Impact Factor
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ABSTRACT: OBJECTIVE: To identify risk factors for development of twin-twin transfusion syndrome (TTTS) in monochorionic diamniotic multiple gestations complicated by midtrimester isolated polyhydramnios (iPoly). STUDY DESIGN: A retrospective study of patients referred for possible TTTS between 16 and 26 gestational weeks was performed. IPoly was defined as a maximum vertical pocket of >= 8 cm in the iPoly twin's sac and >2 and <8 cmin the co-twin's sac on the consultative ultrasound. RESULTS: Of 628 consecutive patients referred for possible TTTS, 74 were diagnosed with iPoly. The majority of these patients (n - 52, 70.3%) were not subsequently diagnosed with TTTS, and of these, 40 were managed expectantly and 12 had amnioreductions because of symptomatic iPoly; 30-day perinatal survival of at-least-one twin in the non-TTTS group was 93.0% (40/43). TTTS developed in the 22 remaining patients, of which 63.6% were of advanced Quintero Stage. Nineteen underwent laser surgery; 30-day perinatal survival of at-least-one twin was 84.2% (16/19). In a multivariate logistic regression model, 2 characteristics were associated with the development of TTTS: (1) gestational age <20 weeks at the time of diagnosis of iPoly (odds ratio, 13.48; 95% confidence interval, 3.40-53.48; P = .0002); and (2) intrauterine growth restriction of the co-twin (odds ratio, 7.28; 95% confidence interval, 1.72-30.88; P = .0071). CONCLUSION: Among referred patients with midtrimester iPoly, 29.7% subsequently developed TTTS. Early diagnosis (<20 weeks) and/or co-twin intrauterine growth restriction were significant risk factors for development of TTTS in these patients.American Journal of Obstetrics and Gynecology 05/2014; 211(3). DOI:10.1016/j.ajog.2014.05.028 · 3.97 Impact Factor