Korean J Obstet Gynecol.  2010 Apr;53(4):324-329. 10.5468/kjog.2010.53.4.324.

The rate and etiologies of second trimester fetal loss in twin pregnancies

• Lee YM
• Shin JS
• Seok JM
• Jang JH
• Kang JH

• KMID: 2273859
• DOI: http://doi.org/10.5468/kjog.2010.53.4.324

Abstract

OBJECTIVE
To evaluate and compare the rate and etiologies of second trimester pregnancy loss in monochorionic (MC) or dichorionic (DC) twins, and natural or assisted reproductive technology (ART) twins.
METHODS
Between January 1997 and December 2008, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2,467 twin pregnancies. They were divided into four groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation and confirmed by histologic examination after delivery. From a total of 2,467 twin deliveries, 392 MC, 2058 DC, and 17 unknown chorionicity were observed. Fertilization methods were classified as 736 natural, 1,590 ART, and 141 unknown conceptions. The pregnancy loss rate and possible mechanisms were compared in each group.
RESULTS
During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities and 45 natural, 78 ART, and 23 unknown fertilizations. Total twin pregnancy loss rate was 5.9% (146/2,467), with 11.0% (43/392) and 4.2% (86/2,058) for MC twin group and DC twin group, respectively. Likewise, it was 6.1% (45/736) and 4.9% (78/1,590) for natural twin group and ART twin group. The most common cause was intrauterine fetal death (IUFD) in 22 (51.2%) in MC twin group and preterm premature rupture of membranes (PPROM) in 40 (46.5%) in DC twin group, followed by preterm labor (PTL) in 37 (43%). In natural pregnancy, IUFD was the most common etiology in 20 (44.5%) and for ART twin group, it was PTL in 35 (44.9%).
CONCLUSION
Twin pregnancy loss rate was higher in MC twin group compared with DC twin group in the second trimester. MC twin group had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC twin group were PPROM and PTL. It is suggested that antenatal care in twin pregnancy should be explored for preventing fetal loss and promoting neonatal well-being.

Keyword

Second trimester pregnancy loss; Chorionicity; Fertilization; Twins

MeSH Terms

Chorion
Female
Fertilization
Fetal Death
Humans
Incidence
Membranes
Obstetric Labor, Premature
Pregnancy
Pregnancy Trimester, Second
Pregnancy, Twin
Reproductive Techniques, Assisted
Rupture
Twins

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