PDF herunterladen
CC BY-NC-ND 4.0 · Journal of Fetal Medicine 2024; 11(02): 107-114
DOI: 10.1055/s-0044-1788647
Original Article

Outcome of Twins Discordant for Major Anomalies

Tseten Zangmu Bhutia
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Geeta Kolar
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Kamala Kavuri
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Saritha Redishetty
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Prathiba Reddy
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Arati Singh
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Smita Pawar
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Mounika Kachakayala
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Raksha Shivaramegowda
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
,
Suseela Vavilala
1   Department of Fetal Medicine, Fernandez Foundation, Hyderabad, Telangana, India
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objectives This article determines the incidence, management, and outcomes of twins discordant for major structural anomalies.

Materials and Methods A retrospective observational study was conducted from 2011 to 2021. Pregnant women discordant for major malformations as confirmed postnatally were included in the study. Demographic and clinical details were collected from medical records. Determining the incidence and profile of twins discordant for major structural anomalies and their management and outcomes were considered as primary objectives that were detailed in dichorionic (DC) and monochorionic (MC) twin pregnancies.

Results A total of 83 subjects were included, with an incidence of 1.76% in DC pregnancies and 1.4% in MC pregnancies. Major structural anomalies among DC twins were musculoskeletal (26%), followed by circulatory system anomalies (20.2%), while among MC twins, the majority were found to be central nervous system anomalies (35.7%). Gastrointestinal system anomalies were found the least, with 5.8% in DC anomalous twins, and none were observed in MC anomalous twins. Live birth rate among anomalous twins was found to be 79.71 and 64.29%, and in normal cotwins, it was 92.75 and 85.71% in DC and MC twins, respectively. Surviving anomalous twins underwent postnatal surgery or intervention in 25/69 (36.2%) DC twins, out of which 20 infants were alive and healthy. In the MC anomalous twin group, 3/14 (21.42%) underwent surgical correction; all were alive and well. Postnatally, babies were followed up until 2 years of life. The survival rate for anomalous twins was 47.82% in DC and 35.7% in MC twins. Normal cotwins had overall favorable outcomes, with a survival rate of 89.8 and 85.7% in DC and MC twins, respectively.

Conclusion In DC twins discordant for major anomalies, expectant management is a safe option.

Keywords

discordant twins - dichorionic twins - monochorionic twins - fetal outcomes - postnatal surgery

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, Dr. Suseela Vavilala, upon reasonable request.


Authors' Contributions

Conception and design: T.Z.B.


Analysis and interpretation of the data: S.V., T.Z.B.


The drafting of the paper: G.K., K.K., S.R., P.R., A.S., S.P., M.K., R.S.


Revising it critically for intellectual content: T.Z.B., S.V.


The final approval of the version: S.V.




Publikationsverlauf

Artikel online veröffentlicht:
25. Juli 2024

© 2024. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ochsenbein-Kölble N. Twin pregnancies. Ultraschall in der Medizin. Eur J Ultrasound 2021; 42 (03) 246-269
    Suche in Google Scholar
  • 2 von Kaisenberg C, Klaritsch P, Ochsenbein-Kölble N, Hodel ME, Nothacker M, Hecher K. Screening, management and delivery in twin pregnancy. Ultraschall Med 2021; 42 (04) 367-378
    Thieme ConnectPubMedSuche in Google Scholar
  • 3 Bianchi D, Crombleholme T, D' Alton M, Malone F. Fetology: Diagnosis and Management of the Fetal Patient. 2nd ed.. McGraw Hill Professional; 2010: 1025
    Suche in Google Scholar
  • 4 Algeri P, Russo FM, Incerti M. et al. Expectant management in di-chorionic pregnancies complicated by discordant anomalous twin. J Perinat Med 2018; 46 (07) 721-727
    CrossrefPubMedSuche in Google Scholar
  • 5 Linskens IH, Elburg RM, Oepkes D, Vugt JM, Haak MC. Expectant management in twin pregnancies with discordant structural fetal anomalies. Twin Res Hum Genet 2011; 14 (03) 283-289
    CrossrefPubMedSuche in Google Scholar
  • 6 Nassar AH, Adra AM, Gómez-Marín O, O'Sullivan MJ. Perinatal outcome of twin pregnancies with one structurally affected fetus: a case-control study. J Perinatol 2000; 20 (02) 82-86
    CrossrefPubMedSuche in Google Scholar
  • 7 Malone FD, Craigo SD, Chelmow D, D'Alton ME. Outcome of twin gestations complicated by a single anomalous fetus. Obstet Gynecol 1996; 88 (01) 1-5
    CrossrefPubMedSuche in Google Scholar
  • 8 Gedikbaşı A, Akyol A, Yildirim G, Ekiz A, Gul A, Ceylan Y. Twin pregnancies complicated by a single malformed fetus: chorionicity, outcome and management. Twin Res Hum Genet 2010; 13 (05) 501-507
    CrossrefPubMedSuche in Google Scholar
  • 9 Sun LM, Chen XK, Wen SW, Fung KF, Yang Q, Walker MC. Perinatal outcomes of normal cotwins in twin pregnancies with one structurally anomalous fetus: a population-based retrospective study. Am J Perinatol 2009; 26 (01) 51-56
    Thieme ConnectPubMedSuche in Google Scholar
  • 10 Chang YL, Chao AS, Cheng PJ. et al. Presence of a single fetal major anomaly in a twin pregnancy does not increase the preterm rate. Aust N Z J Obstet Gynaecol 2004; 44 (04) 332-336
    CrossrefPubMedSuche in Google Scholar
  • 11 Townsend R, Khalil A. Fetal growth restriction in twins. Best Pract Res Clin Obstet Gynaecol 2018; 49: 79-88
    CrossrefPubMedSuche in Google Scholar
  • 12 Balasubramanian R, Vuppalapati S, Avanthika C. et al. Epidemiology, genetics and epigenetics of congenital heart diseases in twins. Cureus 2021; 13 (08) e17253
    PubMedSuche in Google Scholar
  • 13 Mei-Dan E, Jain V, Melamed N. et al. Guideline no. 428: management of dichorionic twin pregnancies. J Obstet Gynaecol Can 2022; 44 (07) 819-834.e1
    CrossrefPubMedSuche in Google Scholar
  • 14 Landon MB, Galan HL, Jauniaux E. et al. Multiple gestations. In: Gabbe's Obstetrics: Normal & Problem Pregnancies. Elsevier; 2021: 751-783
    Suche in Google Scholar
  • 15 Soni S, Gebb JS, Moldenhauer JS. et al. Predictors of dual demise within the first week after selective cord occlusion via radiofrequency ablation for complex monochorionic pregnancies. Am J Obstet Gynecol MFM 2023; 5 (03) 100842-100842
    CrossrefPubMedSuche in Google Scholar
  • 16 Gul A, Cebeci A, Aslan H, Polat I, Sozen I, Ceylan Y. Perinatal outcomes of twin pregnancies discordant for major fetal anomalies. Fetal Diagn Ther 2005; 20 (04) 244-248
    CrossrefPubMedSuche in Google Scholar
  • 17 Rand L, Smith-Bindman R, Saadai P, Machin G, Feldstein V. 141: natural history and outcomes of monochorionic twin pregnancies in a large population-based study. Am J Obstet Gynecol 2009; 201 (06) S66-S67
    CrossrefSuche in Google Scholar
  • 18 Hiersch L, Barrett J, Aviram A. et al. Patterns of discordant growth and adverse neonatal outcomes in twins. Am J Obstet Gynecol 2021; 225 (02) 187.e1-187.e14
    CrossrefPubMedSuche in Google Scholar
  • 19 Kang HJ, Liao AW, Brizot ML, Francisco RP, Krebs VL, Zugaib M. Prediction of intrauterine death and severe preterm delivery in twin pregnancies discordant for major fetal abnormality. Eur J Obstet Gynecol Reprod Biol 2014; 175: 115-118
    CrossrefPubMedSuche in Google Scholar
  • 20 Fernandes TR, Carvalho PR, Flosi FB, Baião AE, Junior SC. Perinatal outcome of discordant anomalous twins: a single-center experience in a developing country. Twin Res Hum Genet 2016; 19 (04) 389-392
    CrossrefPubMedSuche in Google Scholar
  • 21 Homatter C, Robillard PY, Omarjee A. et al. Discordant malformations in monochorionic twins: a retrospective cohort study in La Reunion Island. J Matern Fetal Neonatal Med 2020; 33 (24) 4069-4075
    CrossrefPubMedSuche in Google Scholar
  • 22 Rustico MA, Lanna M, Faiola S. et al. Major discordant structural anomalies in monochorionic twins: spectrum and outcomes. Twin Res Hum Genet 2018; 21 (06) 546-555
    CrossrefPubMedSuche in Google Scholar