Discordant twins: diagnosis, evaluation and management

Miller, Jena L.; Chauhan, Suneet P.; Abuhamad, Alfred

doi:10.1016/j.ajog.2011.06.075

Cited by 128 publications

(118 citation statements)

References 93 publications

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“…Bizim çalışmamızda da tanı anında evreler arasında fark olmasa da amniyoredüksiyon yapılan grupta, Quintero sınıflamasında anlamlı progresyon tespit edilmiştir. İİTS da tanı anında erken gestasyonel haftada bulunmanın, progresyon için risk faktörü olduğu [16] düşünüldüğünde bizim çalışmamız-da evre I ve II hasta sayısı amniyoredüksiyon yapılan grupta 9 ( % 64. 3 ), kontrol grubunda 15 ( % 53.…”

Section: Discussionunclassified

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

2016

Ann Clin Anal Med

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ÖzetAmaç: İkiz -ikiz transfüzyon sendromu (İİTS) tanısı konulan olgularda amniyoredüksiyon yapılmasının perinatal sonuçlarla ilişkisini belirlemek. Gereç ve Yöntem: İİTS tanısı alan 42 hasta çalışmaya dahil edildi. Bu hastalardan amnioredüksiyon yapılan 14 hasta çalışma grubunu, amnioredüksiyon yapılma-yan 28 hasta kontrol grubunu oluşturdu. Amniyoredüksiyonun ikizler üzerin-de doğum haftası, doğum ağırlığı, yenidoğan yoğun bakım ihtiyacı ve perinatal mortalite üzerine etkileri retrospektif olarak medikal kayıtlardan elde edildi. P değeri 0.05 değerinin altında anlamlı kabul edildi. Bulgular: Amniyoredüksiyon yapılan hastalarda doğum haftası 28.7 ± 4.1 iken kontrol grubunda 31.8 ± 4.9 olarak bulundu. Amniyoredüksiyon yapılan hastalarda, 32 hafta altı 12 (%85.7) ve 28 hafta altı 10 (%71.4) hastada doğum görülürken kontrol grubunda, 32 hafta altı 12 (%43.1) ve 28 hafta altı 9 (%32.1) hastada doğum gerçekleşti (P<0.05). Amniyoredüksiyon yapılan hastalarda alıcı ikizin doğum ağırlığı 1385 ± 711 gr iken kontrol grubunda 2104 ± 741 gr olarak bulundu (P<0.05). Amniyoredüksiyon yapılan hastalarda yenidoğanların 24'ü (%92.3) yenidoğan yoğun bakım ihtiyacı duyarken kontrol grubu yenidoğanla-rının 40'ının (% 71.4) yenidoğan yoğun bakım ihtiyacı olmuştur (p=0.11). Tartışma: Çalışmamızda amniyoredüksiyon İİTS olgularında perinatal sonuçlar üzerine olumlu bir etkisi bulunamamıştır. Anahtar Kelimelerİkiz -İkiz Transfüzyon Sendromu; Amniyoredüksiyon; Maternal Sonuç; Perinatal Sonuç Abstract Aim: To assess the effect of amnioreduction on perinatal outcomes in patients with twin -twin transfusion syndrome (TTTS). Material and Method: 42 patients with TTTS were enrolled into this study. 14 of 42 patients who underwent amnioreduction formed the study group and 28 of 42 patients who did not undergo amnioreduction formed the control group. Effects of amnioreduction on average week of birth, birth weight, need of neonatal intensive care and perinatal mortality were gathered from medical records retrospectively. P score under 0.05 was accepted as significant. Results: Average week of birth of women who underwent amnioreduction was 28.7 ± 4.1 however it was 31.8 ± 4.9 on control group. Although number of births under 32 weeks is 12 (85.7%) and under 28 weeks is 10 (71.4%) on patients who underwent amnioreduction, it was 12 (43.1%) for under 32 weeks and 9 (32.1%) for under 28 weeks in control group (P<0.05). Birth weight of recipient twin was 1385 ± 711 gr in amnioreduction group and 2104 ± 741 gr in control group (P<0.05). 40 newborns (71.4%) of the control group needed neonatal intensive care however 24 newborns (92.3%) of the amnioreduction group needed neonatal intensive care (p=0.11). Discussion: In this study, we did not find any positive effect of amnioreduction on perinatal outcomes in pregnant women with TTTS.

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Section: Discussionunclassified

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

2016

Ann Clin Anal Med

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“…Specifically, in 18% of twins, birth weight differs from 500 g to 999 g and the difference is > 1000 g in 3% [6]. A birth weight discrepancy of approximately 20% exists in 15-30% of twins.…”

Section: Incidence Of Discordant Twin Growthmentioning

confidence: 99%

“…A birth weight discrepancy of approximately 20% exists in 15-30% of twins. Furthermore, a discordance of 20% between the largest and the smallest neonate appears in more than 40% of triplet gestations, with 7% exceeding 40% discrepancy [6].…”

Section: Incidence Of Discordant Twin Growthmentioning

confidence: 99%

Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome

Kaponis

Thanatsis

Papadopoulos

et al. 2015

Journal of Perinatal Medicine

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Aim: In the current review study, we present recent data regarding the importance of intertwin estimated fetal weight (EFW) and crown rump length (CRL) discordance for the prediction of adverse perinatal outcome both in monochorionic and in dichorionic diamniotic gestations. Results: Twins with significant weight disparity are associated with higher rates of perinatal morbidity and mortality, regardless of gestational age at delivery. However, there is no agreement regarding as to the cut off value above which the perinatal outcome is unfavorably affected and the threshold range from 10 to 30%. On the other hand, CRL discrepancy has proved to be a weak predictor of adverse outcomes, such as fetal or neonatal death in fetuses without chromosomal and structural abnormalities. In clinical practice, decisions about obstetric surveillance of discordant twin gestations, frequency of fetal sonographic monitoring and time of delivery are usually based on amniotic fluid volume and Doppler assessments on a weekly basis. Conclusion: Significant EFW discordance leads to adverse perinatal outcome, although the cut-off value has not yet been estimated. CRL discrepancy is not correlated well with adverse perinatal outcome. However, increased monitoring of women with EFW and CRL discrepancy is suggested.

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“…Otras variables, como el tamaño de la muestra estudiada y su composición, también afectan a esta discrepancia: algunos trabajos se refieren únicamente a gestaciones gemelares; otros, la mayoría, a gemelos recién nacidos vivos y otros incluyen tanto a éstos como las muertes fetales. Atendiendo a estas variaciones encontramos que entre el 10% y el 30% de los gemelos recién nacidos vivos tienen DPN (Miller et al, 2012;Zhang et al, 2013;Zuppa et al, 2013). En consecuencia, si los gemelos con DPN representan en torno al 10-30% de todos los gemelos, y estos constituyen el 3% de la población nacida, los gemelos con DPN pueden suponer, aproximadamente, entre el 0,3% y el 0,9% de todos los nacimientos (Breathnach et al, 2011).…”

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Discordancia de peso al nacer en gemelos: consecuencias y su perdurabilidad en el desarrollo psicológico

Pérez¹

2014

PSYWRIT

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Cada vez nacen más gemelos con discordancia de peso intrapar, factor de riesgo que puede afectar su desarrollo, especialmente el del hermano de menor peso intrapar. Sin embargo, pocos estudios abordan sus posibles disfunciones más allá de las obstétricas; de modo que el conocimiento acerca de las consecuencias de la discordancia de peso intrapar en su desarrollo psicológico es escaso. Este trabajo revisa la literatura y recapitula las consecuencias de la discordancia de peso intrapar en el desarrollo psicológico de los gemelos de menor peso intrapar, comparativamente a sus hermanos de más peso, así como la perdurabilidad de dichas consecuencias durante su ciclo vital. La literatura revisada muestra que los gemelos de menor peso intrapar obtienen puntuaciones inferiores a sus hermanos en habilidades cognitivas, verbales y psicomotoras; y mayor probabilidad de presentar rasgos asociados al desarrollo de hiperactividad. Estas diferencias persisten desde la infancia hasta la juventud, no existiendo datos referidos a la edad adulta. En conclusión, las consecuencias de la discordancia de peso intrapar sobre el desarrollo psicológico de los gemelos de menor peso intrapar son extensas tanto en las dimensiones afectadas como en su perdurabilidad. Es necesaria una mayor investigación que permita diseñar intervenciones tempranas preventivas y optimizadoras del desarrollo de estos niños; pues el óptimo desarrollo de todos los niños es la base de una sociedad en continuo progreso.Palabras Clave: Gemelaridad; Discordancia de Peso al Nacer; Desarrollo Atípico; Desarrollo Psicológico; Atención Temprana.More twins are being born with intrapair birth weight discordances. Discordance in birth weight is a risk factor that can affect the development of twins, especially that of the lightest twin. However, few studies have analysed the possible consequences of birth weight discordance on the lightest twin beyond possible neonatal obstetric problems. Thus, little is known about the consequences of birth weight discordance on the psychological development of such babies.This article reviews the literature and summarizes the effects of birth weight discordance on the psychological development of the lightest intrapair twins compared with their heavier twin siblings and the persistence of these effects during their lifetime. The literature shows that the lightest intrapair twins obtain lower scores than their siblings in cognitive, verbal, and psychomotor skills. They are also more likely to have traits associated with the development of hyperactivity. These differences persist from childhood to youth. There is no information about adulthood. In conclusion, birth weight discordance has marked effects on the psychological development of intrapair lower weight twins, both in relation to the affected dimensions and the persistence of these effects over time. Further research is needed on designing early preventative interventions that would optimize the development of these children. This proposal is of relevance, given that the optimal dev...

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Discordant twins: diagnosis, evaluation and management

Cited by 128 publications

References 93 publications

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome

Discordancia de peso al nacer en gemelos: consecuencias y su perdurabilidad en el desarrollo psicológico

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