Early demise of twins in a cohort of stillbirths and second trimester miscarriages

Twins, particularly monochorionic (MC) pairs, are at increased risk for fetal death. Whereas previous work has sought to understand the mechanisms for this increased mortality, most studies analyze viable twin pregnancies or liveborn twin cohorts. In the Wisconsin Stillbirth Service Program cohort o...

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Veröffentlicht in:American journal of medical genetics. Part A 2019-03, Vol.179 (3), p.350-355
Hauptverfasser: Korlesky, Colin, McPherson, Elizabeth
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container_title American journal of medical genetics. Part A
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McPherson, Elizabeth
description Twins, particularly monochorionic (MC) pairs, are at increased risk for fetal death. Whereas previous work has sought to understand the mechanisms for this increased mortality, most studies analyze viable twin pregnancies or liveborn twin cohorts. In the Wisconsin Stillbirth Service Program cohort of 3,137 stillbirths and second trimester miscarriages, we identified 175 twin pregnancies for a twinning rate of 56/1,000, which is approximately double the general population. The excess of twins among miscarriages and stillbirths was attributable to MC pairs as the incidence of dizygotic (DZ) twinning was not increased compared to livebirth data. The leading causes of fetal demise among twins were twin–twin transfusion, acardia, and twin–twin disruption. Maternal causes of death, primarily premature rupture of membranes, were moderately increased in both MC and DZ twins relative to singletons. Although deceased twins were smaller than expected for viable twins at comparable gestational ages, placenta weights of deceased MC pairs were large compared to combined fetal weight, which indicates placental inefficiency likely due to vascular shunting. Co‐twin survival was much lower for MC than for DZ pairs. Therefore, earlier diagnosis and treatment of MC twinning complications may decrease prenatal mortality.
doi_str_mv 10.1002/ajmg.a.61014
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Although deceased twins were smaller than expected for viable twins at comparable gestational ages, placenta weights of deceased MC pairs were large compared to combined fetal weight, which indicates placental inefficiency likely due to vascular shunting. Co‐twin survival was much lower for MC than for DZ pairs. 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Although deceased twins were smaller than expected for viable twins at comparable gestational ages, placenta weights of deceased MC pairs were large compared to combined fetal weight, which indicates placental inefficiency likely due to vascular shunting. Co‐twin survival was much lower for MC than for DZ pairs. 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subjects Abortion, Spontaneous - diagnosis
Abortion, Spontaneous - epidemiology
Abortion, Spontaneous - etiology
Cause of Death
Databases, Factual
Female
Fetal Death
fetal demise
Fetuses
Health Surveys
Humans
Miscarriage
Mortality
Placenta
Pregnancy
Pregnancy Trimester, Second
Pregnancy, Twin
Prevalence
Stillbirth
Twins
Twins, Dizygotic
Twins, Monozygotic
twin–twin transfusion
Wisconsin
title Early demise of twins in a cohort of stillbirths and second trimester miscarriages
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