{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:12:42Z","timestamp":1787508762487,"version":"build-2736575974"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T00:00:00Z","timestamp":1576195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003123","name":"Fetal Medicine Foundation","doi-asserted-by":"publisher","award":["1037116"],"award-info":[{"award-number":["1037116"]}],"id":[{"id":"10.13039\/501100003123","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To report and compare pregnancy outcome in dichorionic (DC), monochorionic diamniotic (MCDA) and monochorionic monoamniotic (MCMA) twin pregnancies with two live fetuses at 11\u201313\u2009weeks' gestation and to examine the impact of endoscopic laser surgery for severe twin\u2013twin transfusion syndrome (TTTS) and\/or selective fetal growth restriction (sFGR) on the outcome of MCDA twins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11\u201313\u2009weeks' gestation between 2002 and 2019. In pregnancies with no major abnormalities, we compared overall survival, fetal loss at &lt;\u200924\u2009weeks' gestation, perinatal death at \u2265\u200924\u2009weeks, delivery at &lt;\u200937 and &lt;\u200932\u2009weeks, and birth weight &lt;\u20095\n                      <jats:sup>th<\/jats:sup>\n                      percentile between DC, MCDA and MCMA twins.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study population of 6225 twin pregnancies with two live fetuses at 11\u201313\u2009weeks' gestation with no major abnormalities included 4896 (78.7%) DC, 1274 (20.5%) MCDA and 55 (0.9%) MCMA twins. In DC twins, the rate of loss  at &lt;\u200924\u2009weeks' gestation in all fetuses was 2.3%; this rate was higher in MCDA twins (7.7%; relative risk (RR), 3.258; 95%\u2009CI, 2.706\u20133.923) and more so in MCMA twins (21.8%; RR, 9.289; 95%\u2009CI, 6.377\u201313.530). In DC twins, the rate of perinatal\u2009death at \u2265\u200924\u2009weeks in all twins that were alive at 24\u2009weeks was 1.0%; this rate was higher in MCDA twins (2.5%; RR, 2.456; 95%\u2009CI, 1.779\u20133.389) and more so in MCMA twins (9.3%; RR, 9.130; 95%\u2009CI, 4.584\u201318.184). In DC twins, the rate of preterm birth at &lt;\u200937\u2009weeks' gestation in pregnancies with at least one liveborn twin was 48.6%; this rate was higher in MCDA twins (88.5%; RR, 1.824; 95%\u2009CI, 1.760\u20131.890) and more so in MCMA twins (100%; RR, 2.060; 95%\u2009CI, 2.000\u20132.121). In DC twins, the rate of preterm birth at &lt;\u200932\u2009weeks was 7.4%; this rate was higher in MCDA twins (14.2%; RR, 1.920; 95%\u2009CI, 1.616\u20132.281) and more so in MCMA twins (26.8%; RR, 3.637; 95%\u2009CI, 2.172\u20136.089). In DC twin pregnancies with at least one liveborn twin, the rate of a small\u2010for\u2010gestational\u2010age neonate among all liveborn twins was 31.2% and in MCDA twins this rate was higher (37.8%; RR, 1.209; 95%\u2009CI, 1.138\u20131.284); in MCMA twins, the rate was not significantly different (33.3%; RR, 1.067; 95%\u2009CI, 0.783\u20131.455). Kaplan\u2013Meier analysis showed a significant difference in survival in MCDA and MCMA twins, compared to DC twins, for both the interval of 12 to &lt;\u200924\u2009weeks' gestation (log\u2010rank test,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001 for both) and that of \u2265\u200924 to 38\u2009weeks (log\u2010rank test,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.0001 for both). Endoscopic laser ablation of intertwin communicating placental vessels was carried out in 127 (10.0%) MCDA twin pregnancies for TTTS and\/or sFGR and, in 111 of these, surgery was performed at &lt;\u200924\u2009weeks; both fetuses survived in 62 (55.9%) cases, one fetus survived in 25 (22.5%) cases and there were no survivors in 24 (21.6%) cases. On the extreme assumption that, had laser surgery not been carried out in these cases, all fetuses would have died, the total fetal loss rate at &lt;\u200924\u2009weeks' gestation in MCDA twins would have been 13.5%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The rates of fetal loss at &lt;\u200924\u2009weeks' gestation, perinatal death at \u2265\u200924\u2009weeks and preterm birth are higher in MCDA and more so in MCMA twins than in DC twins. In MCDA twins, the rate of fetal loss may have been reduced by endoscopic laser surgery in those that developed early TTTS and\/or sFGR. These data would be useful in counseling parents as to the likely outcome of their pregnancy and in defining strategies for surveillance and interventions in the management of the different types of twin pregnancy. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.21892","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T09:11:53Z","timestamp":1571130713000},"page":"32-38","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Outcome of twin pregnancy with two live fetuses at 11\u201313\u2009weeks' gestation"],"prefix":"10.1002","volume":"55","author":[{"given":"E.","family":"Litwinska","sequence":"first","affiliation":[{"name":"Harris Birthright Research Centre for Fetal Medicine, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5856-6072","authenticated-orcid":false,"given":"A.","family":"Syngelaki","sequence":"additional","affiliation":[{"name":"Harris Birthright Research Centre for Fetal Medicine, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Cimpoca","sequence":"additional","affiliation":[{"name":"Harris Birthright Research Centre for Fetal Medicine, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Frei","sequence":"additional","affiliation":[{"name":"Harris Birthright Research Centre for Fetal Medicine, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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