Inpatientvsoutpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study

Autor: Saccone, Gabriele, Berghella, Vincenzo, Locci, Mariavittoria, Ghi, Tullio, Frusca, Tiziana, Lanna, Mariano, Faiola, Stefano, Fichera, Anna, Prefumo, Federico, Rizzo, Giuseppe, Bosi, Costanza, Arduino, Bruno, D'Alessandro, Pietro, Borgo, Maria, Arduino, Silvana, Cantanna, Elisabetta, Simonazzi, Giuliana, Rizzo, Nicola, Francesca, Giorgetta, Seravalli, Viola, Miller, Jena L., Magro-Malosso, Elena Rita, Di Tommaso, Mariarosaria, Dall'Asta, Andrea, Galli, Letizia, Volpe, Nicola, Visentin, Silvia, Cosmi, Erich, Sarno, Laura, Caissutti, Claudia, Driul, Lorenza, Anastasio, Hannah, Di Mascio, Daniele, Panici, Pierluigi Benedetti, Vena, Flaminia, Brunelli, Roberto, Ciardulli, Andrea, D'Antonio, Francesco, Schoen, Corina, Suhag, Anju, Gambacorti-Passerini, Zita Maria, Baz, Maria Angeles Anaya, Magoga, Giulia, Busato, Enrico, Filippi, Elisa, Suárez, María José Rodriguez, Alderete, Francisco Gamez, Ortuno, Paula Alonso, Vitagliano, Amerigo, Mollo, Antonio, Raffone, Antonio, Vendola, Marianne, Navaneethan, Preethi, Wimalasundera, Ruwan, Napolitano, Raffaele, Aquino, Carmen Imma, D'Agostino, Serena, Gallo, Cinzia, Maruotti, Giuseppe Maria, Flacco, Maria Elena, Baschat, Ahmet A., Venturella, Roberta, Guida, Maurizio, Martinelli, Pasquale, Zullo, Fulvio
Přispěvatelé: Saccone G, Berghella V, Locci M, Ghi T, Frusca T, Lanna M, Faiola S, Fichera A, Prefumo F, Rizzo G, Bosi C, Arduino B, D'Alessandro P, Borgo M, Arduino S, Cantanna E, Simonazzi G, Rizzo N, Francesca G, Seravalli V, Miller JL, Magro-Malosso ER, Di Tommaso M, Dall'Asta A, Galli L, Volpe N, Visentin S, Cosmi E, Sarno L, Caissutti C, Driul L, Anastasio H, Di Mascio D, Panici PB, Vena F, Brunelli R, Ciardulli A, D'Antonio F, Schoen C, Suhag A, Gambacorti-Passerini ZM, Baz MAA, Magoga G, Busato E, Filippi E, Suárez MJR, Alderete FG, Ortuno PA, Vitagliano A, Mollo A, Raffone A, Vendola M, Navaneethan P, Wimalasundera R, Napolitano R, Aquino CI, D'Agostino S, Gallo C, Maruotti GM, Flacco ME, Baschat AA, Venturella R, Guida M, Martinelli P, Zullo F., Saccone, G., Berghella, V., Locci, M., Ghi, T., Frusca, T., Lanna, M., Faiola, S., Fichera, A., Prefumo, F., Rizzo, G., Bosi, C., Arduino, B., D'Alessandro, P., Borgo, M., Arduino, S., Cantanna, E., Simonazzi, G., Rizzo, N., Francesca, G., Seravalli, V., Miller, J. L., Magro-Malosso, E. R., Di Tommaso, M., Dall'Asta, A., Galli, L., Volpe, N., Visentin, S., Cosmi, E., Sarno, L., Caissutti, C., Driul, L., Anastasio, H., Di Mascio, D., Panici, P. B., Vena, F., Brunelli, R., Ciardulli, A., D'Antonio, F., Schoen, C., Suhag, A., Gambacorti-Passerini, Z. M., Baz, M. A. A., Magoga, G., Busato, E., Filippi, E., Suarez, M. J. R., Alderete, F. G., Ortuno, P. A., Vitagliano, A., Mollo, A., Raffone, A., Vendola, M., Navaneethan, P., Wimalasundera, R., Napolitano, R., Aquino, C. I., D'Agostino, S., Gallo, C., Maruotti, G. M., Flacco, M. E., Baschat, A. A., Venturella, R., Guida, M., Martinelli, P., Zullo, F.
Rok vydání: 2018
Předmět:
Cardiotocography
chorionicity
Twins
Cesarean delivery
cord accident
cord entanglement
healthcare
monochorionic
multiple gestation
perinatal death
respiratory distress syndrome
twin pregnancy
Radiological and Ultrasound Technology
Reproductive Medicine
Radiology
Nuclear Medicine and Imaging
Obstetrics and Gynecology
0302 clinical medicine
Pregnancy
Nuclear Medicine and Imaging
Outpatients
Health care
Prenatal
Medicine
030212 general & internal medicine
Twin Pregnancy
Monochorionic monoamniotic twin pregnancy
Ultrasonography
Cord entanglement
030219 obstetrics & reproductive medicine
Obstetrics
Adult
Female
Fetal Death
Humans
Infant
Newborn
Inpatients
Length of Stay
Live Birth
Perinatal Death
Pregnancy
Twin
Prenatal Care
Retrospective Studies
Statistics
Nonparametric
Twins
Monozygotic
Ultrasonography
Prenatal
Perinatal Mortality
Statistics
General Medicine
cesarean delivery
health care
Radiology
medicine.medical_specialty
Socio-culturale
Monozygotic
Multiple Gestation
03 medical and health sciences
Nonparametric
Radiology
Nuclear Medicine and imaging
business.industry
Infant
Twin
Newborn
Settore MED/40 - Ginecologia e Ostetricia
business
Outpatient management
Zdroj: Ultrasound in Obstetrics & Gynecology. 53:175-183
ISSN: 1469-0705
0960-7692
DOI: 10.1002/uog.19179
Popis: OBJECTIVES: Monoamniotic twin pregnancies are at increased risk of perinatal complications, primarily owing to the risk of cord entanglement. There is no recommendation on whether such pregnancies should be managed in hospital or can be safely managed in an outpatient setting, and the timing of planned delivery is also a subject of debate. The aim of this study was to compare the perinatal outcomes of inpatient vs outpatient fetal surveillance approaches employed among 22 participating study centers, and to calculate the fetal and neonatal death rates according to gestational age, in non-anomalous monoamniotic twins from 26 weeks' gestation. METHODS: The MONOMONO study was a multinational cohort study of consecutive women with monochorionic monoamniotic twin pregnancies, who were referred to 22 university hospitals in Italy, the USA, the UK and Spain, from January 2010 to January 2017. Only non-anomalous uncomplicated monoamniotic twin pregnancies with two live fetuses at 26 + 0 weeks' gestation were included in the study. In 10 of the centers, monoamniotic twins were managed routinely as inpatients, whereas in the other 12 centers they were managed routinely as outpatients. The primary outcome was intrauterine fetal death. We also planned to assess fetal and neonatal death rates according to gestational age per 1-week interval. Outcomes are presented as odds ratio (OR) with 95% CIs. The main outcome was analyzed using both standard logistic regression analysis, in which each fetus was treated as an independent unit, and a generalized mixed-model approach, with each twin pair treated as a cluster unit, considering that the outcome for a twin is not independent of that of its cotwin. RESULTS: 195 consecutive pregnant women with a non-anomalous uncomplicated monoamniotic twin gestation (390 fetuses) were included. Of these, 75 (38.5%) were managed as inpatients and 120 (61.5%) as outpatients. The overall perinatal loss rate was 10.8% (42/390) with a peak fetal death rate of 4.3% (15/348) occurring at 29 weeks' gestation. There was no significant difference in mean gestational age at delivery (31 weeks), birth weight (∼1.6 kg), or emergency delivery rate between the inpatient and outpatient surveillance groups. Based on generalized mixed-model analysis, there was no statistically significant difference in fetal death rates between inpatient management commencing from around 26 weeks compared with outpatient surveillance protocols from 30 weeks (3.3% vs 10.8%; adjusted OR 0.21 (95% CI, 0.04-1.17)). Maternal length of stay in the hospital was 42.1 days in the inpatient group, and 7.4 days in the outpatient group (mean difference 34.70 days (95% CI, 31.36-38.04 days). From 32 + 0 to 36 + 6 weeks, no fetal or neonatal death in either group was recorded. 46 fetuses were delivered after 34 + 0 weeks, and none of them died in utero or within the first 28 days postpartum. CONCLUSION: In uncomplicated monoamniotic twins, inpatient surveillance is associated with similar fetal mortality as outpatient management. After 31 + 6 weeks, and up to 36 + 6 weeks, there were no intrauterine fetal deaths or neonatal deaths. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Databáze: OpenAIRE
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