Twin pregnancy, intrauterine growth restriction, breech presentation – how to improve the outcome?

Abstract

Evidence for the role of first-trimester ultrasound in predicting outcome in twin pregnancies is conflicting. We observed association between crown–rump length (CRL) discordance and adverse perinatal outcome in twin pregnancies. In the absence of aneuploidy or structural fetal abnormality, CRL discordance is of poor predictive value for adverse perinatal outcome in both MC and DC twin pregnancies. CRL discordance should not be used routinely to identify twin pregnancies at high risk of adverse perinatal outcome. MC twins are at increased risk of early fetal loss secondary to vascular complications such as twin–twin transfusion syndrome (TTTS). Early pregnancy loss is significantly more common in MC than in DC twins, but no difference in the prospective risk of mortality between MC and DC twins is evident after 24 weeks’ gestation. Early detection and prompt treatment of complications in MC twins are likely to have contributed to this improvement in outcome.

Method of the delivery is influenced not only with obstetric indications but may also be influenced with economic value. The total cost of delivery in breech presentation may be decreased or increased if external cephalic version (ECV) is attempted with neuraxial anesthesia compared to ECV without it. Increased ECV success with neuraxial anesthesia and the subsequent reduction in breech cesarean delivery rate offset the costs of providing anesthesia to facilitate ECV.

Keywords:dichorionic, monochorionic pregnancy, breech presentation, intrauterine growth restriction, adverse perinatal outcome, crownrump length discordance, twin pregnancies fetal loss