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 |
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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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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.</description><identifier>ISSN: 1552-4825</identifier><identifier>EISSN: 1552-4833</identifier><identifier>DOI: 10.1002/ajmg.a.61014</identifier><identifier>PMID: 30663217</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>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</subject><ispartof>American journal of medical genetics. 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Part A</title><addtitle>Am J Med Genet A</addtitle><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.</description><subject>Abortion, Spontaneous - diagnosis</subject><subject>Abortion, Spontaneous - epidemiology</subject><subject>Abortion, Spontaneous - etiology</subject><subject>Cause of Death</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Fetal Death</subject><subject>fetal demise</subject><subject>Fetuses</subject><subject>Health Surveys</subject><subject>Humans</subject><subject>Miscarriage</subject><subject>Mortality</subject><subject>Placenta</subject><subject>Pregnancy</subject><subject>Pregnancy Trimester, Second</subject><subject>Pregnancy, Twin</subject><subject>Prevalence</subject><subject>Stillbirth</subject><subject>Twins</subject><subject>Twins, Dizygotic</subject><subject>Twins, Monozygotic</subject><subject>twin–twin transfusion</subject><subject>Wisconsin</subject><issn>1552-4825</issn><issn>1552-4833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kDtPwzAUhS0EoqWwMSNLLAyk-Jk6Y1WVAipCQjBbtuO0qfIodqKq_x6HlA4MTPfq6rtH5xwArjEaY4TIg9qUq7EaxxhhdgKGmHMSMUHp6XEnfAAuvN8gRBGfxOdgQFEcU4InQ_A-V67Yw9SWubewzmCzyysP8woqaOp17Zru6Ju8KHTumrWHqkqht6YOo3F5aX1jHQzfRjmXq5X1l-AsU4W3V4c5Ap-P84_ZU7R8WzzPpsvI0JixiKdETwiZZFowQ2wikDZGc5xYbbTmTFiUJJgGLFWp4UIbxrU2whjMSUo4HYG7Xnfr6q82-JCdC1sUqrJ162XIl9CEUdqht3_QTd26KrjrKCEYSUQSqPueMq723tlMbkNA5fYSI9l1LbuupZI_XQf85iDa6tKmR_i33ACwHtjlhd3_KyanL6-Laa_7Dbgaivo</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Korlesky, Colin</creator><creator>McPherson, Elizabeth</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2608-9459</orcidid><orcidid>https://orcid.org/0000-0002-6374-2330</orcidid></search><sort><creationdate>201903</creationdate><title>Early demise of twins in a cohort of stillbirths and second trimester miscarriages</title><author>Korlesky, Colin ; McPherson, Elizabeth</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3644-5d2b7227fb84c2e980bccb519ebcbb548e099135d2dadc58bc45bbc8cc152d253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abortion, Spontaneous - diagnosis</topic><topic>Abortion, Spontaneous - epidemiology</topic><topic>Abortion, Spontaneous - etiology</topic><topic>Cause of Death</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Fetal Death</topic><topic>fetal demise</topic><topic>Fetuses</topic><topic>Health Surveys</topic><topic>Humans</topic><topic>Miscarriage</topic><topic>Mortality</topic><topic>Placenta</topic><topic>Pregnancy</topic><topic>Pregnancy Trimester, Second</topic><topic>Pregnancy, Twin</topic><topic>Prevalence</topic><topic>Stillbirth</topic><topic>Twins</topic><topic>Twins, Dizygotic</topic><topic>Twins, Monozygotic</topic><topic>twin–twin transfusion</topic><topic>Wisconsin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Korlesky, Colin</creatorcontrib><creatorcontrib>McPherson, Elizabeth</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of medical genetics. Part A</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Korlesky, Colin</au><au>McPherson, Elizabeth</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early demise of twins in a cohort of stillbirths and second trimester miscarriages</atitle><jtitle>American journal of medical genetics. Part A</jtitle><addtitle>Am J Med Genet A</addtitle><date>2019-03</date><risdate>2019</risdate><volume>179</volume><issue>3</issue><spage>350</spage><epage>355</epage><pages>350-355</pages><issn>1552-4825</issn><eissn>1552-4833</eissn><abstract>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.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>30663217</pmid><doi>10.1002/ajmg.a.61014</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-2608-9459</orcidid><orcidid>https://orcid.org/0000-0002-6374-2330</orcidid></addata></record> |
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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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