Evaluation of perinatal outcome of monochorionic twin pregnancies in a single perinatology clinic

INTRODUCTION: Monochorionic twin pregnancies carry high perinatal risks due to shared placental circulation, predisposing them to complications such as twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), and selective fetal growth restriction (sFGR). Early recognition and timely intervention are essential to improve neonatal survival. This study evaluates the perinatal outcomes of monochorionic twin pregnancies managed at a single perinatology center.
METHODS: A retrospective cross-sectional study was conducted using medical records from January 2020 to December 2023. Forty-six monochorionic twin pregnancies were analyzed for maternal factors, obstetric complications, and neonatal outcomes. Statistical analyses included Pearson correlation, t-tests, and chi-square tests.
RESULTS: The mean gestational age at delivery was 32.46±4.48 weeks. The average birth weight of the first twin was 1809.76±797.37 g and that of the second twin was 1683.13±887.06 g. Mean APGAR scores were 7.15±2.74 and 8.41±2.69 for the first twin, and 6.80±3.12 and 8.11±3.14 for the second twin, at one and five minutes, respectively. TTTS occurred in 8.7% and sFGR in 50% of pregnancies. Higher birth weights were significantly correlated with better APGAR scores (p<0.01), whereas advanced TTTS and sFGR were associated with lower birth weights and adverse neonatal outcomes.
DISCUSSION AND CONCLUSION: Monochorionic twin pregnancies are associated with increased risks of prematurity, low birth weight, and neonatal distress, particularly in the presence of TTTS and sFGR. Reporting outcomes with measures of variability highlights the substantial heterogeneity in neonatal status. Routine surveillance and timely interventions remain essential to improving perinatal survival.

Keywords: Monochorionic twins, neonatal morbidity, perinatal outcomes, selective fetal growth restriction, twin anemia-polycythemia sequence, twin-to-twin transfusion syndrome.