Objective The purpose of this study was to evaluate the impact of noncentral placental cord insertion on birthweight discordance in twins. Study Design We performed a multicenter, prospective trial ...of twin pregnancies. Placental cord insertion was documented as central, marginal, or velamentous according to a defined protocol. Association of the placental cord insertion site with chorionicity, birthweight discordance, and growth restriction were assessed. Results Eight hundred sixteen twin pairs were evaluated; 165 pairs were monochorionic, and 651 pairs were dichorionic. Monochorionic twins had higher rates of marginal ( P = .0068) and velamentous ( P < .0001) placental cord insertion. Noncentral placental cord insertion was more frequent in smaller twins of discordant pairs than control pairs (29.8% vs 19.1%; P = .004). Velamentous placental cord insertion in monochorionic twins was associated significantly with birthweight discordance (odds ratio, 3.5; 95% confidence interval, 1.3–9.4) and growth restriction (odds ratio, 4; 95% confidence interval, 1.1–14.3). Conclusion Noncentral placental cord insertion contributes to birthweight discordance in monochorionic twin pregnancies. Sonographic delineation of placental cord insertion may be of value in antenatal assessment of twin pregnancies.
Prediction of safe and successful vaginal twin birth Breathnach, Fionnuala M., MD; McAuliffe, Fionnuala M., MD; Geary, Michael, MD ...
American journal of obstetrics and gynecology,
09/2011, Letnik:
205, Številka:
3
Journal Article, Conference Proceeding
Recenzirano
Objective The objective of the study was to establish predictors of vaginal twin birth and evaluate perinatal morbidity according to mode of delivery. Study Design One thousand twenty-eight twin ...pregnancies were prospectively recruited. For this prespecified secondary analysis, obstetric characteristics and a composite of adverse perinatal outcome were compared according to the success or failure of a trial of labor and further compared with those undergoing elective cesarean delivery. Perinatal outcomes were adjusted for chorionicity and gestational age using a linear model for continuous data and logistic regression for binary data. Results Nine hundred seventy-one twin pregnancies met the criteria for inclusion. A trial of labor was considered for 441 (45%) and was successful in 338 of 441 (77%). The cesarean delivery rate for the second twin was 4% (14 of 351). Multiparity and spontaneous conception predicted vaginal birth. No statistically significant differences in perinatal morbidity were observed. Conclusion A high prospect of successful and safe vaginal delivery can be achieved with trial of twin labor.
Detection of foetal growth restriction using third trimester ultrasound Bricker, Leanne, MB Bch, MRCOG; Mahsud-Dornan, Samina, MB BCh, MD, MRCOG; Dornan, James C., MD, FRCOG, FRCPI
Best practice & research. Clinical obstetrics & gynaecology,
12/2009, Letnik:
23, Številka:
6
Journal Article
Recenzirano
Foetal growth restriction is an important contributor to perinatal mortality, being responsible for up to 50% of stillbirths. Optimal prevention and accurate detection enabling timely intervention ...remain elusive, particularly in presumed low-risk pregnancy. Third trimester ultrasound seems a logical solution, but systematic review of evidence from randomised trials has shown that third trimester ultrasound does not have a significant impact on perinatal mortality but may increase interventions such as caesarean delivery. However, the evidence is difficult to interpret in the context of current obstetric practice as the evolution of ultrasound technology and rapid assimilation of newer techniques has resulted in questionable validity of the findings. If third trimester ultrasound were introduced routinely, there is a need to decide the optimal timing and number of examinations and what ultrasound parameters should be used to identify the foetus at risk.
