Discordant growth in twins

Kingdom, John; Nevo, Ori; Murphy, Kellie

doi:10.1002/pd.1262

Cited by 40 publications

(20 citation statements)

References 61 publications

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“…The occurrence of any diseases in twins raises the issue of phenotypic concordance or discordance and the subsequent issue of managing pregnancy, patients, parents and decision making events [6]. Risk assessment for the apparently healthy twin, genetic counselling and parental psychological assistance must be part of the clinical follow-up.…”

Section: Emerging Issues In Twinsmentioning

confidence: 99%

Prematurity and twinning

Giuffrè

Piro

Corsello

2012

The Journal of Maternal-Fetal & Neonatal Medicine

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Aim of the study: Newborns from multiple pregnancies are increasing in number and demonstrate a higher perinatal morbidity and mortality compared to singletons. Prematurity is the main reason for most neonatal diseases in twins, but other variables may play a role and their prenatal evaluation may improve the overall outcome. Main findings: Prematurity is six times more frequent in twins and therefore birth weight is significantly lower compared to singletons. Thus, twins are more exposed to prematurity related diseases (respiratory, cardiovascular, infectious, etc.) and to long-term complications (especially neurological disabilities). Results: It is very difficult to estimate the increased risk of neonatal morbidity related to twinning independently to the increased risk of prematurity and therefore to interpret data on morbidity rates, in particular regarding the neurodevelopmental outcome. Conclusion: Prevention of preterm birth is a primary goal in managing multiple pregnancies, together with prophylaxis with corticosteroids in order to improve foetal lung maturity. Accurate risk assessment strategies and adequate obstetrical-neonatological management of multiple pregnancies may reduce the increasing need for neonatal intensive care and for health resources in the long-term follow-up that has been observed over the last decades.

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Section: Emerging Issues In Twinsmentioning

confidence: 99%

Prematurity and twinning

Giuffrè

Piro

Corsello

2012

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Perinatal mortality of singletons is increased significantly after 42 weeks whereas perinatal mortality in twins starts to increase significantly after 37 weeks [19]. Prospective risk of fetal death in twin pregnancies, however, rises with advancing gestation, and it ranges between 0.2% and 0.4% per gestational week between 32 and 38 weeks' gestation [20]. Robinson et al [21] suggested that for women with uncomplicated monochorionic twins, the preferred timing of delivery is between 36 and 38 weeks' gestation to decrease fetal loss.…”

Section: Discussionmentioning

confidence: 99%

Clinical factors affecting the timing of delivery in twin pregnancies

et al. 2014

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ObjectiveTo investigate clinical factors affecting the timing of delivery in twin pregnancies in order to minimize perinatal complications.MethodsA retrospective study involved 163 twin pregnancies delivered from January 2006 to September 2011 at Gachon University Gil Medical Center. These cases were divided into three groups based on the delivery timing: less than 32 weeks' gestation (group A), between 32 and 35+6 weeks' gestation (group B), and over 36 weeks' gestation (group C). Clinical factors including maternal age, parity, presence of premature uterine contraction, presence of premature rupture of membrane, white blood cell, high sensitive C-reactive protein level, cervical dilatation, maternal complication, chorionicity, twin specific complication, and perinatal complication were analyzed for each group.ResultsIn group B, the timing of delivery was postponed for 14 days or more from the time of admission, and there were fewer numbers of babies with low Apgar score at birth compared with other groups. The frequency of uterine contraction (P<0.001), presence of premature rupture of membranes (P=0.017), dilatation of cervix (P<0.001), increased white blood cell and high sensitive C-reactive protein levels (P=0.002, P<0.001) were important clinical factors during decision making process of delivery timing in twin pregnancies. Twin specific fetal conditions, such as twin-twin transfusion syndrome and discordant growth (over 25% or more) were shown more frequently in group A. However, there were no significant statistical differences among three groups (P=0.06, P=0.14).ConclusionProper management for preventing premature contraction and inflammation can be essential in twin pregnancies until 32 weeks' gestation, and may decrease maternal and perinatal complications.

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“…Birth weight discordance was calculated as the difference between birth weights divided by the birth weight of the larger twin [(larger birth weight − smaller birth weight)]/larger birth weight × 100%)] [9]. Degree of discordance was defined as median value of discordance in spontaneously conceived twins and those conceived by IVF.…”

Section: Methodsmentioning

confidence: 99%

Degree and Rate of Growth Discordance in Dichorionic Twins Conceived by In Vitro Fertilization

Egić

Mojovic

Milovanovic

et al. 2014

Obstetrics and Gynecology International

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Objective. Our objective was to estimate degree and rate of discordant growth and its impact on perinatal outcome in dichorionic twin pregnancies conceived by in vitro fertilization (IVF) compared to those conceived spontaneously. Study Design. Growth discordance was defined as 90th percentiles for the study population. Adverse perinatal outcome was defined as 5-minute Apgar score <7 and/or admission to neonatal intensive care unit. Results. In the total study population of dichorionic twins (176 conceived by IVF and 215 spontaneously), 30% discordant growth represented the 90th percentile. After adjusting for gestational age, discordant twins conceived by IVF or spontaneously were at higher risk for adverse perinatal outcome (hazard ratio 4.4; 95% CI 2.4–8.3, P < 0.0001; hazard ratio 2.5; 95% CI 1.5–4.4, P = 0.001, resp.). Similar rates of 5-minute Apgar score <7, admission to neonatal intensive care unit, and delivery <34 weeks were found between discordant twins conceived by IVF and those conceived spontaneously. Conclusion. Dichorionic twins conceived by IVF are at similar risk for the rate and degree of discordant growth and adverse perinatal outcome compared to dichorionic twins conceived spontaneously.

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Discordant growth in twins

Cited by 40 publications

References 61 publications

Prematurity and twinning

Prematurity and twinning

Clinical factors affecting the timing of delivery in twin pregnancies

Degree and Rate of Growth Discordance in Dichorionic Twins Conceived by In Vitro Fertilization

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