Maternal and perinatal outcomes of dichorionic diamniotic twin pregnancies diagnosed with vanishing twin syndrome: a retrospective analysis from a single clinical center
Abstract
Objectives: Multiple pregnancies are known to be associated with adverse maternal and perinatal complications. However, data regarding the outcomes of spontaneously reduced twin pregnancies are limited. In the current study we aimed to evaluate the consequences of the vanishing twin syndrome (VTS) in dichorionic diamniotic twin pregnancies for both mother and baby in our perinatal center.
Material and methods: A total of 711 pregnancies were included into the study. 51 cases of vanishing twin syndrome constituted Group 1, 235 cases of normal twins constituted Group 2, and 425 singleton pregnancies formed Group 3. The pregnancies that had multifetal reduction and monochorionic twinning were excluded from both study group and twin control group. The collected data were as follows: age, gravidity, parity, gestational week at birth, delivery route, birth weight, obstetric complications, and maternal and perinatal outcomes.
Results: No significant difference was observed between the groups regarding mean maternal age (p > 0.05). Mean birth weight, gestational age at birth and preterm birth ratio were significantly lower in the Group 2 when compared with Group 1 and Group 3 (all p < 0.001). Adverse perinatal outcomes including very low birth weight (VLBV) and low Apgar scores were more common in Group 1 (p < 0.05), but no significant difference was found between the groups in terms of neonatal intensive care unit admission and perinatal mortality ratios (p > 0.05). Obstetric complications such as preeclampsia, gestational diabetes and intrauterine growth restriction were significantly higher in Group 2 than in Group 1 and Group 3 (all p < 0.05). However, severe maternal morbidities were similar among three groups (p = 0.141).
Conclusions: VTS is seems to be associated with VLBV and low Apgar scores. However, the incidence of severe maternal and perinatal morbidity and mortality in pregnancies with VTS is similar to other pregnancies.
Keywords: vanishing twinsperinatal outcomematernal morbidityrisk factorsvery low birth weight
References
- Chauhan SP, Scardo JA, Hayes E, et al. Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol. 2010; 203(4): 305–315.
- Hamilton BE, Martin JA, Osterman MJ, et al. Births: Final Data for 2014. Natl Vital Stat Rep. 2015; 64(12): 1–64.
- Doyle P. The outcome of multiple pregnancy. Hum Reprod. 1996; 11 Suppl 4: 110–7; discussion 118.
- Levi S. Ultrasonic assessment of the high rate of human multiple pregnancy in the first trimester. J Clin Ultrasound. 1976; 4(1): 3–5.
- Landy HJ, Keith LG. The vanishing twin: a review. Hum Reprod Update. 1998; 4(2): 177–183.
- Steinkampf MP, Whitten SJ, Hammond KR. Effect of spontaneous pregnancy reduction on obstetric outcome. J Reprod Med. 2005; 50(8): 603–606.
- Dickey RP, Taylor SN, Lu PY, et al. Spontaneous reduction of multiple pregnancy: incidence and effect on outcome. Am J Obstet Gynecol. 2002; 186(1): 77–83.
- POSNER AC, KLEIN MA. Fetus papyraceus: recognition and significance. Obstet Gynecol. 1954; 3(1): 106–110.
- Moore CM, McAdams AJ, Sutherland J. Intrauterine disseminated intravascular coagulation: a syndrome of multiple pregnancy with a dead twin fetus. J Pediatr. 1969; 74(4): 523–528.
- Melnick M. Brain damage in survivor after in-utero death of monozygous co-twin. Lancet. 1977; 2(8051): 1287.
- Rydhström H, Ingemarsson I. Prognosis and long-term follow-up of a twin after antenatal death of the co-twin. J Reprod Med. 1993; 38(2): 142–146.
- Okamura K, Murotsuki J, Tanigawara S, et al. Funipuncture for evaluation of hematologic and coagulation indices in the surviving twin following co-twin's death. Obstet Gynecol. 1994; 83(6): 975–978.
- Evron E, Sheiner E, Friger M, et al. Vanishing twin syndrome: is it associated with adverse perinatal outcome? Fertil Steril. 2015; 103(5): 1209–1214.
- American Collage of Obstetrics and Gynecology. Obstetric Care Consensus No. 5: Severe Maternal Morbidity: Screening and Review. Obstet Gynecol. 2016; 128(3): e54–60.
- La Sala GB, Villani MT, Nicoli A, et al. Effect of the mode of assisted reproductive technology conception on obstetric outcomes for survivors of the vanishing twin syndrome. Fertil Steril. 2006; 86(1): 247–249.
- Shebl O, Ebner T, Sommergruber M, et al. Birth weight is lower for survivors of the vanishing twin syndrome: a case-control study. Fertil Steril. 2008; 90(2): 310–314.
- Racowsky C. High rates of embryonic loss, yet high incidence of multiple births in human ART: is this paradoxical? Theriogenology. 2002; 57(1): 87–96.
- Tummers P, De Sutter P, Dhont M. Risk of spontaneous abortion in singleton and twin pregnancies after IVF/ICSI. Hum Reprod. 2003; 18(8): 1720–1723.
- Sun L, Jiang LX, Chen HZ. Obstetric outcome of vanishing twins syndrome: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017; 295(3): 559–567.
- Chasen ST, Luo G, Perni SC, et al. Are in vitro fertilization pregnancies with early spontaneous reduction high risk? Am J Obstet Gynecol. 2006; 195(3): 814–817.
- Pharoah POD, Glinianaia SV, Rankin J. Congenital anomalies in multiple births after early loss of a conceptus. Hum Reprod. 2009; 24(3): 726–731.
- Rodríguez-González M, Serra V, Garcia-Velasco JA, et al. The "vanishing embryo" phenomenon in an oocyte donation programme. Hum Reprod. 2002; 17(3): 798–802.
