Perinatal loss among twins
The Permanente Journal
|April 8, 2011
Summary
Monochorionic diamniotic placentation significantly increases perinatal loss risk in twins. Early identification and management of preterm birth are crucial for reducing twin mortality.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Perinatal loss in twins is a significant concern in obstetric care.
- Understanding contributing factors is essential for improving outcomes.
Purpose of the Study:
- To evaluate prenatal factors associated with perinatal loss in twins.
- To identify the primary perinatal events leading to twin mortality.
Main Methods:
- Retrospective cohort study of 550 twins (monochorionic diamniotic or diamniotic dichorionic).
- Analysis of maternal risk factors and clinical events from medical records and death certificates.
- Univariable and multivariable logistic regression for risk factor assessment.
Main Results:
- Overall perinatal loss rate of 4.2% (12 stillbirths, 34 neonatal deaths).
- Strong association found between monochorionic diamniotic placentation and perinatal loss (aOR 3.9).
- Placental pathology (36%) and spontaneous preterm birth (41%) were key contributing events.
Conclusions:
- Monochorionic diamniotic placentation is the strongest risk factor for twin perinatal loss.
- Early ultrasound identification and subspecialist referral may reduce loss.
- Preventing spontaneous preterm birth remains critical for reducing twin mortality.
Related Concept Videos
01:07Teratogenicity
The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
01:27Ovarian Cycle
The menstrual cycle includes a critical component known as the ovarian cycle, which undergoes two main phases each month—the follicular phase and the luteal phase. The follicular phase is variable and averaging around 14 days. Ovulation, triggered by a surge in luteinizing hormone (LH), marks the transition between the two phases. The second phase, the luteal phase, is relatively consistent, lasting approximately 14 days, and is marked by the activity of the corpus luteum. While a cycle length...
01:20Pathophysiology of Diabetes
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
01:29Nondisjunction
During meiosis, chromosomes occasionally separate improperly. This occurs due to failure of homologous chromosome separation during meiosis I or failed sister chromatid separation during meiosis II. In some species, notably plants, nondisjunction can result in an organism with an entire additional set of chromosomes, which is called polyploidy. In humans, nondisjunction can occur during male or female gametogenesis and the resulting gametes possess one too many or one too few chromosomes.