Complications of twin pregnancies
Languages of publication
Twin pregnancy in the population of Europe is relatively common. One in eighty deliveries results in at least two newborns’ coming to the world. Parents expecting twins are usually excited about the vision of large family, however for an obstetrician a multiple pregnancy is a challenge that involves more complications than singleton pregnancy. The risk of complications exceeds 50%, therefore twin pregnancies are considered as high risk. The most common complication is premature birth, which may result in respiratory failure of the newborn, necrotizing enterocolitis or intracranial hemorrhage. Other complications, that are characteristic for twin pregnancies only, are intrauterine growth restriction, intrauterine fetal death one of the fetuses, hemodynamic disorders due to the connecting blood vessels within the placenta in a monochorionic pregnancy or umbilical cord collision in a monoamniotic pregnancy. Perinatal care in a multiple pregnancy should include a determination of chorionicity and amionicity, prevention of premature labor and rapid diagnosis and treatment of complications. Over 75% of twin pregnancies are delivered via caesarian section which is also burdened with sequelae. Likewise, women pregnant with more than one fetuses suffer from anemia, hypertension, hyperemesis gravidarum and intrahepatic cholestasis of pregnancy more often than those in singleton pregnancies. Despite frequent complications, thanks to intensive perinatal care (numerous gynecological and ultrasound examinations, in some cases the necessity of hospitalization), perinatal mortality decreases and more twins develop properly each year.
-  Smits J, Monden C. Twinning across the Developing World. Newell M-L, ed. PLoS ONE, 2011; 6(9): e25239.
-  Dudenhausen JW, Maier RF. Perinatal Problems in Multiple Births. Deutsches Ärzteblatt International 2010; 107(38): 663-668
-  Elster N. Less is more: the risks of multiple births. Fertility and Sterility. 2000 Oct; 74(4): 617-23
-  Montgomery KS, Cubera S, Belcher C, et al. Childbirth Education for Multiple Pregnancy: Part 1: Prenatal Considerations. The Journal of Perinatal Education. 2005; 14(2): 26-35.
-  Vitthala S, Gelbaya TA, Brison DR, Fitzgerald CT, Nardo LG. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Human Reproduction Update. 2009 Jan; 15(1), 45–55
-  Montgomery KS, Cubera S, Belcher C, et al. Childbirth Education for Multiple Pregnancy: Part 2: Intrapartum and Postpartum Considerations. The Journal of Perinatal Education. 2005; 14(3): 33-38.
-  Ropacka-Lesiak M, Szaflik K, Bręborowicz G., The diagnostic algorithm in twin pregnancy. Ginekol Pol. 2015; 86(3): 210-218
-  Chowdhury HR, Thompson S, Ali M et al. Causes of Neonatal Deaths in a Rural Subdistrict of Bangladesh: Implications for Intervention. Journal of Health, Population, and Nutrition. 2010; 28(4): 375-382.
-  Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep 2015; 64: 1–64.
-  Refuerzo JS, Momirova V, Peaceman AM, Sciscione A, Rouse DJ, Caritis SN, et al. Neonatal outcomes in twin pregnancies delivered moderately preterm, late preterm, and term. Am J Perinatol 2010; 27:5 37–42.
-  Simchen MJ, Okrent Smolar AL, Dulitzky M, Sivan E, Morag I. Neonatal morbidities and need for intervention in twins and singletons born at 34–35 weeks of gestation. J Perinat Med 2016; 44: 887–892.
-  Ward, RM, Beachy JC. Neonatal complications following preterm birth. BJOG: An International Journal of Obstetrics & Gynaecology 2003, 110: 8–16.
-  Bonanno C, Wapner RJ. Antenatal corticosteroids in the management of preterm birth: are we back where we started? Obstet Gynecol Clin North Am. 2012 Mar; 39(1): 47-63.
-  Wen SW, Fung Kee Fung K, Oppenheimer L, Demissie K, Yang Q, Walker M. Neonatal mortality in second twin according to cause of death, gestational age, and mode of delivery. Am J Obstet Gynecol. 2004 Sep; 191(3): 778-83.
-  Glinianaia SV, Rankin J, Wright C. Congenital anomalies in twins: a register-based study. Human Reproduction. 2008 June; 23(6): 1306–1311.
-  Sperling L, Kiil C, Larsen LU. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins. Ultrasound Obstet Gynecol. 2007 May; 29(5): 517-26.
-  Dawson AL, Tinker SC, Jamieson DJ, et al. Twinning and major birth defects, National Birth Defects Prevention Study, 1997–2007. Journal of epidemiology and community health. 2016; 70(11): 1114-1121.
-  Zhang XH, Qiu LQ, Huang JP. Risk of birth defects increased in multiple births. Birth Defects Res A Clin Mol Teratol. 2011 Jan; 91(1): 34-8.
-  Li SJ, Ford N, Meister K, Bodurtha J. Increased risk of birth defects among children from multiple births. Birth Defects Res A Clin Mol Teratol. 2003 Oct; 67(10): 879-85.
-  Tang Y, Ma CX, Cui W et al. The risk of birth defects in multiple births: a population-based study. Matern Child Health J. 2006 Jan; 10(1): 75-81.
-  Mastroiacovo P, Castilla EE, Arpino C et al. Congenital malformations in twins: an international study. Am J Med Genet. 1999 Mar 12; 83(2): 117-24
-  Sebire NJ, Snijders RJ, Hughes K, et al. The hidden mortality of monochorionic twin pregnancies. BJOG 1997; 104: 1203–1207.
-  Peeva G, Bower S, Orosz L, et al. Endoscopic placental laser coagulation in monochorionic diamniotic twins with type II selective fetal growth restriction. Fetal Diagn Ther 2015; 38:86–93.
-  Wu D, Huang L, He Z, et al. Preeclampsia in twin pregnancies: association with selective intrauterine growth restriction. J Matern Fetal Neonatal Med 2016; 29: 1967–1971.
-  Hillman SC, Morris RK, Kilby MD. Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynecol 2011; 118: 928–940.
-  Lewi L, Deprest J, Hecher K, et al. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am J Obstet Gynecol 2013; 208:19–30
-  Townsend R, Khalil A. Twin pregnancy complicated by selective growth restriction. Current Opinion in Obstetrics and Gynecology. 2016 Dec; 28(6): 485–491,
-  Enbom JA. Twin pregnancy with intrauterine death of one twin. Am J Obstet Gynecol. 1985; 152: 424 – 9.
-  Woo HH, Sin SY, Tang LC. Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management. Hong Kong Med J. 2000; 6: 293-300
-  Blickstein I, Perlman S. (2012). Single fetal death in twin gestations. Journal of Perinatal Medicine, 2012; 41(1): 65-69.
-  Santema JG, Swaak AM, Wallenburg HC. Expectant management of twin pregnancy with single fetal death. Br J Obstet Gynaecol. 1995; 102: 26-30.
-  Hillman SC, Morris RK, Kilby MD. Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynecol. 2011; 118: 928-40.
-  Ong SS, Zamora J, Khan KS, Kilby MD. Prognosis for the co-twin following single-twin death: a systematic review. Br J Obstet Gynaecol. 2006; 113: 992-8.
-  Adzick N. S. Open fetal surgery for life- threatening fetal anomalies. Semin. Fetal Neonatalm Med. 2010; 15: 1-8.
-  Barbachowska A, Baliś M, Krzanik K et al. Intrauterine fetal surgery. World Scientific News 2017; 76; 5-15
-  Luks F. New and/or improved aspects of fetal surgery. Prenat. Diagn. 2011; 31: 252-258.
-  Wagner S, Repke JT, Ural SH. Overview and Long-term Outcomes of Patients Born With Twin-to-Twin Transfusion Syndrome. Reviews in Obstetrics and Gynecology. 2013; 6(3-4): 149-154.
-  Spaczyński M, Woytoń J, Macierowski L et al. Aktualny stan wiedzy na temat terapii prenatalnej. Stanowisko grupy ekspertów PTG. Ginekol. Dypl. 2008, wyd. specj. 108-141.
-  Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. 2004. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 351: 136–144.
-  Kalyani R, Bindra MS. Twin Reversed Arterial Perfusion Syndrome (TRAP or Acardiac Twin)-A Case Report. Journal of Clinical and Diagnostic Research : JCDR. 2014; 8(1): 166-167.
-  Hartge DR, Weichert J. Prenatal diagnosis and outcome of multiple pregnancies with reversed arterial perfusion (TRAP-sequence). Archives of Gynecology and Obstetrics. 2012; 286(1): 81
-  Kähler C, Eichhorn KH, Seewald HJ. Diagnosis of a twin-reversed-arterial-perfusion-syndrome (TRAP) in the first trimester of pregnancy—report on two cases. Ultraschall Med. 2003; 24(5): 345-348
-  Robie GF, Payne GG Jr, Morgan MA. Selective delivery of an acardiac, acephalic twin. N Engl J Med. 1989; 320(8): 512–513
-  Quintero RA, Chmait RH, Murakoshi T et al. Surgical management of twin reversed arterial perfusion sequence. Am J Obstet Gynecol 2006; 94(4): 982-991
-  Zollner U, Rehn M, Heuer S et al. Umbilical cord entanglement in monoamniotic twins. Ultrasound Obstet Gynecol. 2012 Jul; 40(1): 121-2
-  Hubinont C, Lewi L, Bernard P et al. Anomalies of the placenta and umbilical cord in twin gestations. Am J Obstet Gynecol. 2015 Oct; 213(4): 91-102.
-  Faber R, Stepan H. Picture of the Month: Umbilical cord entanglement in monoamniotic twins. Ultrasound Obstet Gynecol 2004; 24: 592-593
-  Conde-Agudelo A, Belizán JM, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol. 2000 Jun; 95(6 Pt 1): 899-904.
-  Dera A, Breborowiczg H, Keith L. Twin pregnancy-physiology, complications and the mode of delivery. Archives of Perinatal Medicine. 2007; 13: 1673-5.
-  Mei Y, Gao L, Lin Y et al. Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies. The Journal of Maternal-Fetal & Neonatal Medicine. 2017; 29(13): 1-5.
Publication order reference