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Antepartum Evaluation of Monochorionic Diamniotic (MD) Twins; MD‐Twin Score: A New Scoring Method for Perinatal Outcome
Author(s) -
Kaneko Masatoki,
Sameshima Hiroshi,
Ikeda Tomoaki,
Kodama Yuki,
Ikenoue Tsuyomu
Publication year - 2000
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2000.tb01292.x
Subject(s) - medicine , obstetrics , logistic regression , twin pregnancy , pregnancy , monochorionic twins , amniotic fluid , live birth , gestational age , prom , birth weight , retrospective cohort study , fetus , surgery , biology , genetics
Objective: Our purpose was to establish a new scoring method to survey monochorionic diamniotic (MD) twins during antepartum periods. Study Design: A retrospective study was performed regarding MD twins delivered between January 1992 and July 1996. Maternal and neonatal records were assessed for the following 5 perinatal variables; birth‐weight discordance, amniotic‐fluid discordance, hydrops fetalis, umbilical‐cord insertion, and fetal‐heart‐rate monitoring. Each variable was coded as normal or abnormal and then assigned an arbitrary weight of 0 if normal and 1 if abnormal, yielding a range of scores from 0 (all normal) to 5 (all abnormal). The relationships between individual variables and their combinations and the outcome of pregnancy was determined. A poor pregnancy outcome consisted of intrauterine death, neonatal death, or neurological sequelae of at least one twin. The 5‐variable combination was termed as the MD‐twin score. A chi‐square test and logistic regression analysis were used to determine statistical significance. Results: There were 59 MD pregnancies, of which 13 pregnancies resulted in a poor outcome. The single variable that most likely contributed to a poor outcome was amniotic‐fluid discordance. All 35 pregnancies with an MD‐twin score of ≤ 2 had a good outcome. There were 14 pregnancies with a score of 3, and 21% of them had a poor outcome. All of the pregnancies with a score of ≥ 4 had a poor outcome. When we chose the MD‐twin score of 3 as the critical point for a poor outcome, the likelihood ratio statistics became the highest of any single variable or any combination of variables. Conclusion: The MD‐twin score predicted poor outcomes better than did any single variable or combination of variables.