Does the Timing of a Loss of One Twin Affect the Risk for Preterm Birth?
BACKGROUND AND PURPOSE:
Single intrauterine death (sIUD) of one twin is associated with co-twin demise and preterm birth (PTB)
Previous research suggested the rate of PTB was 68% in monochorionic (MC) twin and 54% in dichorionic (DC) twin pregnancies
Limitations include small number of cases | lack of stratification according by GA at sIUD | heterogeneity in perinatal
D’Antonio et al. (Ultrasound in Obstetrics & Gynecology, 2017) sought to determine whether gestational age at sIUD is associated with PTB
Retrospective cohort study
Women with twin pregnancies in 9 hospitals participating in Southwest Thames Obstetric Research Collaborative (STORK), over a 10-year period from 2000
Women entered into routine care by 11 weeks
Cases with double fetal loss or sIUD occurring at or after 34 weeks were excluded from analysis
Twin-to-twin transfusion syndrome (TTTS), termination of pregnancy and fetal or chromosomal abnormality, pregnancies of unknown chorionicity, MC monoamniotic and high-order multiple gestations were also excluded
Ultrasound data were matched to hospital delivery records and to a mandatory national register for stillbirth and neonatal loss
Fetal loss: Defined as spontaneous death occurring after 14 weeks of gestation
The relative risk (RR) of PTB was assessed
At < 34, < 32, and < 28 weeks of gestation in twin pregnancies complicated by sIUD
Compared to pregnancies without fetal loss
The risk of PTB at < 34 weeks was stratified according to the gestational age at diagnosis of sIUD
Chorionicity subgroup analysis also performed
Risk of PTB at < 34 weeks of gestation after sIUD was explored according to the gestational age at death using 3 time periods
14–19 weeks | 20–25 weeks | 26–32 weeks
Determine the risk of PTB, stratified according to gestational age at diagnosis of sIUD
Following exclusion for miscarriage, TTTS and sIUD >34 weeks, 3013 twin pregnancies were included
2,469 DC and 544 MC
Incidence of IUD was higher in MC twins (3.9%) compared with DC twin pregnancies (1.9%)
Odds ratio (OR) of 2.0 (95% CI, 1.2–3.4; P < 0.006).
Median gestational age at birth was lower in pregnancies complicated by sIUD (32 weeks) compared with those that were not (36.7 weeks) (P < 0.001)
The trend persisted when stratifying by chorionicity (P < 0.0001 for both MC and DC pregnancies)
Compared to twin pregnancies without fetal loss, the risk of PTB was higher in pregnancies with sIUD
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