Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth

Lewi, Liesbeth; Gucciardo, Léonardo; Huber, Agnes; Jani, Jacques; Mieghem, Tim Van; Doné, Elisa; Cannie, Mieke; Gratacós, Eduard; Diemert, Anke; Lewi, Paul; Deprest, Jan

doi:10.1016/j.ajog.2008.04.022

Cited by 193 publications

(176 citation statements)

References 16 publications

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“…often seen in nsIUGR twins than in sIUGR twins. Our findings led us to question whether sIUGR and nsIUGR arise from different mechanisms regarding placental angio-structure, the former being related to vascular communication, as described in previous studies, 3,5,14,15 and the latter to placental insufficiency. Also, we wondered if the older maternal age in the nsIUGR-related cases is a predictor of placental insufficiency.…”

Section: Discussionmentioning

confidence: 93%

Intrauterine growth restriction in monochorionic-diamniotic twins

Machado

Brizot

Miyadahira

et al. 2014

Rev. Assoc. Med. Bras.

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IntrauterIne growth restrIctIon In monochorIonIc-dIamnIotIc twIns rev assoc med Bras 2014; 60(6):585-590 585Original articleIntrauterine growth restriction in monochorionic-diamniotic twins Conflict of interest: noneObjective: to evaluate neonatal morbidity and mortality in monochorionic--diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10 th percentile on twins' growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16).Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR.

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Section: Discussionmentioning

confidence: 93%

Intrauterine growth restriction in monochorionic-diamniotic twins

Machado

Brizot

Miyadahira

et al. 2014

Rev. Assoc. Med. Bras.

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“…A major factor influencing the obstetrical management, in particular the timing of delivery, is the increased risk (9-15%) of intrauterine fetal demise (IUFD) in the smaller twin (Lewi et al, 2008a;Lewi et al, 2008b;Lewi et al, 2010). In case of IUFD, which may occur unexpectedly, the larger co-twin may exsanguinate through the vascular anastomoses, resulting in double fetal demise or cerebral injury due to hypoxic injury (Lewi et al, 2008b;Lewi et al, 2010).…”

mentioning

confidence: 99%

Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin

et al. 2012

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Fetal growth restriction in singletons has been shown to enhance fetal lung maturation and reduce the risk of respiratory distress syndrome due to increased endogenous steroid production. However, data on lung maturation in growth-discordant monochorionic (thus, identical) twins are lacking. Our objective was to compare the risk of severe neonatal morbidity between the larger and the smaller twin in monochorionic twins with birth weight discordance (BWD). We included in the study all consecutive monochorionic diamniotic pregnancies with severe BWD (≥25%) and two live-born twins delivered at our center (n = 47 twin pairs). We compared the incidence of neonatal morbidity, particularly respiratory distress syndrome (RDS), and cerebral lesions between the larger and the smaller co-twin. The incidence of severe neonatal morbidity in the larger and smaller twin was 38% (18/47) and 19% (9/47), respectively (odds ratio (OR) 2.66, 95% confidence interval (CI) 0.94-7.44) and was due primarily to the higher incidence of RDS, 32% (15/47) and 6% (3/47), respectively (OR 6.88, 95% CI 1.66-32.83). In conclusion, this study shows that the larger twin in monochorionic twin pairs with BWD is at increased risk of severe neonatal morbidity, particularly RDS, compared to the smaller twin.

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“…17 The rationale for this early-onset discordant growth in monochorionic twins has been attributed to unequal placental sharing whereas transfusion imbalance has been attributed to the lateonset discordant growth. 18 Likewise to these differing intrinsic placental pathologies, that the uterine artery related parameters may differ due to chorionicity has been studied in this study.…”

Section: Discussionmentioning

confidence: 99%