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Prospective study of the MD ‐twin score for antepartum evaluation of monochorionic diamniotic twins and its correlation with perinatal outcomes
Author(s) -
Oohashi Masanao,
Kaneko Masatoki,
Sameshima Hiroshi,
Kodama Yuki,
Ikenoue Tsuyomu
Publication year - 2014
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/jog.12258
Subject(s) - medicine , obstetrics , percentile , monochorionic twins , gestation , twin to twin transfusion syndrome , gestational age , twin pregnancy , prospective cohort study , umbilical cord , incidence (geometry) , amniotic fluid , birth weight , fetus , pregnancy , statistics , physics , mathematics , anatomy , biology , optics , genetics
Aim To assess the outcome of monochorionic diamniotic ( MD ) twins with the aid of the MD ‐twin score. Methods We enrolled 112 MD ‐twin women in a tertiary perinatal center from 1997 to 2009. The MD ‐twin score was prospectively applied once per week to women who did not have twin‐to‐twin transfusion syndrome ( TTTS ) after 26 weeks of gestation. The MD ‐twin score consists of five variables: (i) fetal weight discordance; (ii) amniotic fluid discordance; (iii) hydrops fetalis; (iv) umbilical cord insertion; and (v) fetal heart rate monitoring. Normal was assigned a value of 0, abnormal was assigned 1, and total score was used for evaluation. Women with scores of 2 at 26 weeks gestation were managed expectantly until the score reached 3. Outcome measures were fetal death, neonatal death and neurological sequelae. The incidence of poor outcome according to score was investigated. The characteristics of MD twins with poor outcome were investigated. Results MD ‐twin scores were applied to 90 women. Among them, 79 had scores of 2 or less and all had good outcomes. There were 11 women with a score of 3, four of whom had adverse outcome for at least one twin. Neonates born to women with scores of 0–2 had good outcomes without respect to birthweight percentile, while neonates with scores of 3 had poor outcomes when their birthweight percentile was less than the third percentile. Conclusion The MD ‐twin score is applicable to 90% of MD twins without TTTS . An MD ‐twin score of 2 is reassuring, while a score of 3 indicates increased risks for adverse outcome.