Perinatal outcome of monochorionic in comparison to dichorionic twin pregnancies

ABSTRACT

The aim of this study is to compare the neonatal outcomes of monochorionic and dichorionic twin pregnancies. A retrospective cohort study involving 51 twin pregnancies followed and delivered at Sultan Qaboos University Hospital was conducted between January 2006 and December 2011. Thirty six [71%] pregnancies were dichorionic diamniotic [DCDA], 14 [27%] were monochorionic diamniotic [MCDA], and one [2%] was monochorionic monoamniotic [MCMA]. The antepartum complications noted in the 15 monochorionic twins were discordant fetal growth in 2 [14%] cases, low birth weight in 11 [73%] babies, pre-eclampsia in three mothers [21%] and twin to twin transfusion syndrome in four [29%] cases. Fetal respiratory distress affected eight [57%] of the pregnancies. Six [40%] twin sets were delivered before 30 weeks, 4 [27%] sets at 31 to 32 weeks, 2 [13%] sets at 34-35 weeks, 2 [13%] sets at 36-37 weeks, and 1 [7%] at 37-38 weeks. Fifteen mothers delivered 16 live infants, 9 [30%] stillbirths and 5 [17%] died after birth. Most neonatal deaths were due to neonatal sepsis and pulmonary hypoplasia. Dichorioinic twins, [DC] morbidity was seen in 11% and 40% for monochoroinic twins [MC]. Mortality rate was 17% for DC and 47% for MC twins. Perinatal morbidity and mortality remain high among monochorionic twins. This is likely due to frequent twin-to-twin transfusion syndrome, prematurity, fetal growth restriction and intrauterine fetal death. Improved fetal and neonatal management may result in improved outcomes: