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Impact of first trimester determination of abnormal cord insertion on twin‐to‐twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study
Author(s) -
Saito Mizue,
Tokunaka Mayumi,
Takita Hiroko,
Goto Minako,
Machi Maya,
Sekiya Bunbu,
Arakaki Tatsuya,
Hamada Shoko,
Oba Tomohiro,
Matsuoka Ryu,
Sekizawa Akihiko
Publication year - 2020
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5633
Subject(s) - medicine , retrospective cohort study , obstetrics , monochorionic twins , gestation , cohort , incidence (geometry) , cord , first trimester , pregnancy , gynecology , surgery , biology , genetics , physics , optics
Objective To assess the influence of abnormal cord insertion (CI) detected by first trimester ultrasonography on the development of twin‐to‐twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twins. Method In this retrospective cohort study, consecutive patients with MCDA twins who underwent fetal ultrasound screening in the first trimester between January 2011 and January 2017 were enrolled. The CI sites were evaluated between 11 + 0 and 13 + 6 weeks' gestation. All twin pairs were assigned to the abnormal CI group (twin pair with velamentous cord insertion (VCI) and/or marginal cord insertion (MCI) in one or both twins) or the normal CI group (twin pair with both normal CI). The relationships of adverse outcomes in two groups were analyzed. Results A total of 109 MCDA twin pairs were examined; 15 cases were classified into the abnormal CI group and 94 cases into the normal CI group. The incidence of TTTS was significantly higher in the abnormal than in the normal CI group (26.7% vs 7.45%, P = .04). In patients who developed TTTS, all donors had VCI. Conclusion Ultrasound evaluation of abnormal CI at 11 + 0 to 13 + 6 weeks' gestation in MCDA twins is valuable in the assessment of the risk for TTTS.