OBJECTIVE: We sought to determine the perinatal risks associated with growth discordance in appropriately grown twin gestations. STUDY DESIGN: We conducted a retrospective cohort study of all twin gestations excluding those complicated by monoamnionicity, twin-twin transfusion syndrome, structural anomalies, selective reduction, or a birthweight <10th percentile. Growth discordance was defined as ≥20%. Outcomes considered were stillbirth, preterm delivery <34 weeks and <28 weeks, and admission to the neonatal intensive care unit. Analyses were stratified by chorionicity. RESULTS: Of 895 included dichorionic pregnancies, 63 (7.0%) were discordant. Discordant dichorionic twins were not at increased risk of preterm delivery <34 weeks (34.9% vs 25.6%; relative risk [RR], 1.4; 95% confidence interval [CI], 1.0-1.9), preterm delivery <28 weeks (3.2% vs 2.8%; RR, 1.1; 95% CI, 0.3-4.8), or admission to intensive care (26.9% vs 23.5%; RR, 1.5; 95% CI, 1.0-2.3). We had >90% power to detect a 2.5-fold increase in preterm delivery and admission to the neonatal intensive care unit in dichorionic twins. Of 250 monochorionic pregnancies, 23 (9.2%) were discordant. Monochorionic twin pregnancies were at increased risk of preterm delivery <34 weeks (65.2% vs 26.4%; RR, 2.5; 95% CI, 1.7-3.6), preterm delivery <28 weeks (34.8% vs 4.0%; RR, 8.8; 95% CI, 3.7-20.5), and admission to intensive care (68.2% vs 23.3%; RR, 2.9; 95% CI, 2.0-4.3). CONCLUSION: In appropriately grown twins, growth discordance is a risk factor for adverse perinatal outcomes in monochorionic, but not dichorionic, twins. Discordant monochorionic twins may benefit from increased antenatal surveillance.
OBJECTIVE: We sought to determine the perinatal risks associated with growth discordance in appropriately grown twin gestations. STUDY DESIGN: We conducted a retrospective cohort study of all twin gestations excluding those complicated by monoamnionicity, twin-twin transfusion syndrome, structural anomalies, selective reduction, or a birthweight <10th percentile. Growth discordance was defined as ≥20%. Outcomes considered were stillbirth, preterm delivery <34 weeks and <28 weeks, and admission to the neonatal intensive care unit. Analyses were stratified by chorionicity. RESULTS: Of 895 included dichorionic pregnancies, 63 (7.0%) were discordant. Discordant dichorionic twins were not at increased risk of preterm delivery <34 weeks (34.9% vs 25.6%; relative risk [RR], 1.4; 95% confidence interval [CI], 1.0-1.9), preterm delivery <28 weeks (3.2% vs 2.8%; RR, 1.1; 95% CI, 0.3-4.8), or admission to intensive care (26.9% vs 23.5%; RR, 1.5; 95% CI, 1.0-2.3). We had >90% power to detect a 2.5-fold increase in preterm delivery and admission to the neonatal intensive care unit in dichorionic twins. Of 250 monochorionic pregnancies, 23 (9.2%) were discordant. Monochorionic twin pregnancies were at increased risk of preterm delivery <34 weeks (65.2% vs 26.4%; RR, 2.5; 95% CI, 1.7-3.6), preterm delivery <28 weeks (34.8% vs 4.0%; RR, 8.8; 95% CI, 3.7-20.5), and admission to intensive care (68.2% vs 23.3%; RR, 2.9; 95% CI, 2.0-4.3). CONCLUSION: In appropriately grown twins, growth discordance is a risk factor for adverse perinatal outcomes in monochorionic, but not dichorionic, twins. Discordant monochorionic twins may benefit from increased antenatal surveillance.
Authors: Melissa M Amyx; Paul S Albert; Alaina M Bever; Stefanie N Hinkle; John Owen; William A Grobman; Roger B Newman; Edward K Chien; Robert E Gore-Langton; Germaine M Buck Louis; Katherine L Grantz Journal: Am J Obstet Gynecol Date: 2019-08-24 Impact factor: 8.661
Authors: Yair J Blumenfeld; Valerija Momirova; Dwight J Rouse; Steve N Caritis; Anthony Sciscione; Alan M Peaceman; Uma M Reddy; Michael W Varner; Fergal D Malone; Jay D Iams; Brian M Mercer; John M Thorp; Yoram Sorokin; Marshall W Carpenter; Julie Lo; Susan M Ramin; Margaret Harper Journal: J Ultrasound Med Date: 2014-12 Impact factor: 2.153
Authors: Nasim C Sobhani; Teresa N Sparks; Kristen A Gosnell; Larry Rand; Juan M Gonzalez; Vickie A Feldstein Journal: Am J Perinatol Date: 2020-12-15 Impact factor: 3.079
Authors: Amira S Egic; Donka V Mojovic; Zagorka M Milovanovic; Aleksandar B Jurisic; Ljubomir P Srbinovic; Suzana P Krsmanovic; Natasa T Karadzov-Orlic Journal: Obstet Gynecol Int Date: 2014-07-07