3 years ago

Does the Site of The Cord Insertion increase the risk of Adverse Outcome, Twin-To-Twin Transfusion Syndrome and Discordant Growth in monochorionic twin pregnancies?

Nada Mourad Tawfic, Liesbeth Lewi, Luc De Catte, Jan Deprest, Isabel Couck, Roland Devlieger
BACKGROUND It is insufficiently known to what degree the site of the cord insertions influences the risk of a complicated outcome in monochorionic twin pregnancies. OBJECTIVES The purpose is to examine if the site of cord insertions as determined on prenatal ultrasound scan increases the risk of adverse outcome -defined as fetal or neonatal loss or birth prior to 32 weeks-, twin-to-twin transfusion syndrome (TTTS) and discordant growth. METHODS We retrospectively studied a consecutive cohort of monochorionic diamniotic twin pregnancies followed from the first trimester. We divided the cohort into three groups of increasing discordance in cord insertion sites: concordant (normal-normal; marginal-marginal; velamentous-velamentous), intermediate (normal-marginal; marginal-velamentous) and discordant (normal-velamentous) insertion sites. We examined the association between adverse outcome, TTTS and discordant growth and the following predictors: the 3 groups of insertion sites and the presence of a velamentous insertion in one or both twins. Additionally, we examined if the discordance in insertion sites or rather a velamentous insertion in one or both twins determines the risk of adverse outcome, TTTS and discordant growth. RESULTS 518 pregnancies were included. In univariate analysis, a discordant and a velamentous insertion in one twin increased the risk of adverse outcome, TTTS and discordant growth. An intermediate insertion only increased the risk of discordant growth. A velamentous insertion in both twins increased the risk of an adverse outcome and TTTS, but not of discordant growth. Multivariate logistic regression analysis showed a velamentous insertion in one or both twins to independently predict adverse outcome and TTTS. For discordant growth, both an intermediate/discordant and a velamentous cord insertion in one twin were independent predictors. CONCLUSIONS A velamentous cord in one or both twins increases the risk of an adverse outcome and TTTS irrespective of the discordance in the insertion sites, whereas the risk of discordant growth is determined by both the discordance in insertion sites and a velamentous cord insertion in one twin.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18926

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