{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:13:49Z","timestamp":1770747229318,"version":"3.49.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of the study was to introduce a goal-concordant outcome framework and evaluate the independent effects of chorionicity, fetal weight discordance \u226525%, and intrauterine fetal surgery on survival, timing of delivery, and neonatal growth in twin pregnancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included 1,860 twin pregnancies delivered \u226524\u202fweeks at a national referral center between 2012 and 2023: 1,097 pregnancies were dichorionic (DC), 559 were monochorionic without intervention (MC), and 204 were monochorionic with intrauterine surgery (MCS; 167 fetoscopic laser procedures and 37 selective reductions). The primary outcome was goal-concordant survival (GCS), defined as dual survival in DC and MC pregnancies, dual survival after laser therapy, or intended singleton survival after selective reduction. The secondary outcomes included goal-concordant week (GCW), defined as delivery within guideline-based gestational age windows, and goal-concordant weight (GCWt), defined as birthweight \u22651,500\u202fg in all surviving neonates. Independent predictors of failure to achieve each outcome were assessed using a multivariable logistic regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GCS was achieved in 99.0% of the DC, 98.4% of the MC, and 79.9% of the MCS pregnancies, including 78.4% after laser therapy and 86.5% after selective reduction. In a multivariable analysis, MCS was the strongest independent predictor of failure to achieve GCS (OR: 21.2, 95% CI: 10.5\u201342.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), while fetal weight discordance \u226525% remained an additional independent risk factor (OR: 2.0, 95% CI: 1.1\u20133.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.018). GCW was achieved in 52.1% of the DC, 54.2% of the MC, and 37.9% of the MCS pregnancies. Failure to achieve GCW was independently associated with fetal weight discordance \u226525% in DC and MC twins (OR: 2.9\u20133.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2264\u202f0.002) and with MCS even in the absence of significant discordance (OR: 1.66,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006). GCWt was achieved in 82.9% of the DC, 69.4% of the MC, and 52.3% of the MCS pregnancies. Failure to achieve GCWt was most strongly associated with fetal weight discordance \u226525% in DC twins (OR 7.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Across chorionicity groups, pregnancies with fetal weight discordance \u226525% delivered 12\u201319\u202fdays earlier and had neonatal birthweights reduced by approximately 680\u2013800\u202fg.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chorionicity, fetal weight discordance, and intrauterine fetal surgery independently and differentially affect survival, delivery timing, and neonatal growth. Goal-concordant outcomes provide a clinically intuitive, guideline-aligned benchmark for counseling and outcome comparison in twin pregnancies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1726115","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T06:51:27Z","timestamp":1770706287000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Goal-concordant outcomes in twin pregnancies: impact of chorionicity, fetal weight discordance, and fetal surgery in a 12-year prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Lubom\u00edr","family":"Ha\u0161l\u00edk","sequence":"first","affiliation":[{"name":"Institute for the Health of Mother and Child","place":["Prague, Czechia"]},{"name":"3rd Medical Faculty, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ladislav","family":"Krofta","sequence":"additional","affiliation":[{"name":"Institute for the Health of Mother and Child","place":["Prague, Czechia"]},{"name":"3rd Medical Faculty, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Hanul\u00edkov\u00e1","sequence":"additional","affiliation":[{"name":"Institute for the Health of Mother and Child","place":["Prague, Czechia"]},{"name":"3rd Medical Faculty, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mat\u00fa\u0161","family":"Halaj","sequence":"additional","affiliation":[{"name":"Institute for the Health of Mother and Child","place":["Prague, Czechia"]},{"name":"3rd Medical Faculty, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbora","family":"Be\u0148ov\u00e1","sequence":"additional","affiliation":[{"name":"Institute for the Health of Mother and Child","place":["Prague, Czechia"]},{"name":"3rd Medical Faculty, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji\u0159\u00ed","family":"Han\u00e1\u010dek","sequence":"additional","affiliation":[{"name":"Institute for the Health of Mother and Child","place":["Prague, Czechia"]},{"name":"3rd Medical Faculty, Charles University","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1055\/s-2001-12937","article-title":"Adverse perinatal outcome of twin pregnancies according to chorionicity: review of the 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