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P19.03: Regional and provider differences in management and pregnancy outcomes of monochorionic–diamniotic (MCDA) twins
Author(s) -
Datkhaeva I.,
Paek B.,
Walker M.,
Rao R.,
Scibetta E.,
Afshar Y.,
Wong T.,
Platt L.D.,
Han C.S.
Publication year - 2018
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.19769
Subject(s) - medicine , demographics , obstetrics , vaginal delivery , caesarean delivery , pregnancy , descriptive statistics , caesarean section , demography , statistics , mathematics , sociology , biology , genetics
Objectives: To elucidate regional and provider differences in management and outcomes of MCDA pregnancies around the world from Facebook (FB) group members. Methods: Cross-sectional survey of members of a Facebook (FB) group called ‘‘MoDi twins’’. REDCAP survey was posted for five days with daily reminders. Participants were collected through ‘‘snowballing,’’ whereby individuals shared the survey to assist with recruiting. Data was analysed using Stata to explore descriptive statistics on demographics, provider type, frequencies of ultrasound screening and pregnancy outcomes. Categorical variables were analysed using Chi-squared using a p-value of < 0.05. Results: Among 2,169 participants, 486 (22.4%) had TTTS and 134 (6.2%) had TAPS. The lowest rate of TTTS development was in the Southern US (16.6%) and the highest rate was outside of the US (35.8%, p<0.001). The total number of patients who delivered within the ACOG recommended timing of 34’0-37’6 weeks was 68.3%. This rate was significantly less outside of the US (58.7%) due to increased rate of deliveries before 34 weeks (34.2% outside of US vs 26.5% within US, p<0.001). 29.3% of patients had a vaginal delivery of both babies, 68.7% had a Caesarean for both and 2.0% had a combination. Patients managed by a CNM or OB were more likely to have a vaginal delivery (40.4% vs 27.4% with MFM involvement, p<0.001). There were no national or international geographic differences in mode of delivery (p=0.187). The overall take-home baby rate was 90% for both babies and 96% for at least one baby, and this rate rises if MFM is involved, 91.2% and 97.6%, (p<0.001). Conclusions: Regional and provider differences exist in management and pregnancy outcomes of MCDA twins. Patients with MCDA are more likely to be delivered at earlier gestational ages outside of the US. While patients primarily managed by a CNM or OB are more likely to have a vaginal delivery of both infants, the take-home baby rates are highest in those at least co-managed with an MFM.