ArticleFrontiers in medicine2026
Goal-concordant outcomes in twin pregnancies: impact of chorionicity, fetal weight discordance, and fetal surgery in a 12-year prospective cohort study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: The objective of the study was to introduce a goal-concordant outcome framework and evaluate the independent effects of chorionicity, fetal weight discordance ≥25%, and intrauterine fetal surgery on survival, timing of delivery, and neonatal growth in twin pregnancies. Methods: This prospective cohort study included 1,860 twin pregnancies delivered ≥24 weeks 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 ≥1,500 g in all surviving neonates. Independent predictors of failure to achieve each outcome were assessed using a multivariable logistic regression analysis. Results: 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: 10.5-42.6, Conclusion: 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.
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