Early neonatal morbidity and mortality in growth‐discordant twins

Machado, Rita de Cássia Alam; Brizot, Maria de Lourdes; Liao, Adolfo Wenjaw; Krebs, Vera Lúcia Jornada; Zugaib, Marcelo

doi:10.1080/00016340802649808

Cited by 40 publications

(34 citation statements)

References 24 publications

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“…Our findings about higher early neonatal mortality rate for MC twins are in contrast to a recent report [14]. One potential explanation for the contradictionary finding might be the exclusion of pregnancies complicated by TTTS in the reported study cohort.…”

Section: Discussioncontrasting

confidence: 56%

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Perinatal morbidity and early neonatal mortality in twin pregnancies

Peter¹,

Wenzlaff²,

Kruempelmann³

et al. 2013

OJOG

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Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p < 0.01), decreased gestational ages (p < 0.01), increased rates of mechanical ventilation (p < 0.05) and higher early neonatal mortality rates (p < 0.05). Additional risk factors for perinatal morbidity and adverse early neonatal outcome were prematurity (<36 completed weeks of gestation), severe intertwin birth weight discordance > 25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age > 36 completed weeks was accompanied by a decrease of early neonatal complications (p < 0.05). Pregnancies conceived by IVF/ ICSI didn't differ from the overall study cohort regarding the investigated risk factors. Conclusions: Twin pregnancies complicated by prematurity, AIS and severe intertwin birth weight discordance are associated with higher perinatal morbidity and adverse early neonatal outcome. In addition, MC twins are jeopardized by an increased early neonatal mortality and therefore represent considerable challenges to both obstetricians and neonatologists. Based on our results, we recommend such twin pregnancies to be monitored and delivered at tertiary perinatal care centres to minimize perinatal morbidity and adverse early neonatal outcomes.

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Section: Discussioncontrasting

confidence: 56%

“…With a discordance of >25%, there is an increased risk of caesarean section delivery for nonreassuring fetal heart rate tracing, neonatal acidosis, admission to NICU, and respiratory distress syndrome [14,23].…”

Section: Discussionmentioning

confidence: 99%

Perinatal morbidity and early neonatal mortality in twin pregnancies

Peter¹,

Wenzlaff²,

Kruempelmann³

et al. 2013

OJOG

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“…Birth weight (BW) discordance of ≥20% occurs in about 16% of twin pregnancies, irrespective of chorionicity . Differences in weight can be explained by genetic factors (in case of dizygosity) or the influence of sex hormones in utero (in case of unlike‐sex pairs) but are mostly due to unequal sharing of the monochorionic (MC) placenta or to a difference in size of the two dichorionic (DC) placentas . Furthermore, in MC placentas, the vascular anastomoses with subsequent intertwin transfusion may influence fetal growth.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic prediction of birth weight discordance in twin pregnancies

et al. 2015

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Intertwin birth weight discordance is best predicted by an intertwin EFW discordance at the last ultrasound. If discordance is not suspected by ultrasound, the vast majority had no birth weight discordance. In case of birth weight discordance, the presence of at least one growth-restricted twin is very likely. However, because around 20% of concordantly grown twin pairs comprise at least one intrauterine growth restriction infant, one cannot rely on weight discordance alone.

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“…This issue has not been fully explained and some authors argue that discordant growth is not an independent risk factor for fetal or neonatal morbidity and mortality (Cohen et al, 2001;Yinon et al, 2005), since the latter could depend on intrauterine growth restriction RECEIVED 14 December, 2010;ACCEPTED 14 April, 2011. ADDRESS FOR CORRESPONDENCE: Simonetta Frezza, Division of Neonatology -Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy. E-mail: simofrezza@yahoo.it, dandrea.vito@gmail.com (Machado et al, 2009;Yinon et al, 2005), low birthweights, and preterm delivery (Cooperstock et al, 2000;Vergani et al, 2004), which are strongly associated with twin discordance. The present study was aimed at evaluating whether discordance is an independent risk factor for adverse neonatal outcome in the smaller twin of twin pregnancies.…”

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confidence: 99%

Is Growth-Discordance in Twins a Substantial Risk Factor in Adverse Neonatal Outcomes?

et al. 2011

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To evaluate whether growth discordance is an independent risk factor in the neonatal outcome of the smaller twin, all medical records of twin pregnancies delivered between 26 and 41 weeks during a 5-year period (January 2004–December 2008) were reviewed. Among the 49 selected twins, weight discordance was 15–20% in 7 infants, 21–30% in 16 infants, 31–40% in 16 infants and > 40% in 10 infants. No significant differences between the four groups were found with regards to obstetric complications and neonatal disease. Occurrence of birthweight below the 10th percentile and rate of admission to the neonatal intensive care unit significantly increased as intra-pair birthweight difference increased (p = .03). The > 40% discordant group had a significantly lower gestational age (p = .03), lower birthweight (p = .007) and a significantly higher mortality rate (4/10 versus 3/39 p = .04) in comparison with the other discordant groups. Multiple logistic regression analysis showed that birthweight was the single independent and consistent factor associated with elevated risks of mortality. For every 250 g increase in birthweight, the risk for mortality decreased by about 84% [RR 0.16(CI 0.00-0.70)]. Gestational age was the most reliable predictor for major neonatal complications. For every 1-week increase in gestational age a significant decreased risk for all outcomes was found. Discordance alone should not be considered as a predictor for adverse neonatal outcome. Neonatal outcome in discordant twins appears to be related to gestational age and birthweight rather than to the degree of discordance.

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Early neonatal morbidity and mortality in growth‐discordant twins

Abstract: Early perinatal morbidity is increased in twin pregnancies with birthweight discordance > or =20% only when associated with fetal growth restriction and low birthweight.

Cited by 40 publications

References 24 publications

Perinatal morbidity and early neonatal mortality in twin pregnancies

Perinatal morbidity and early neonatal mortality in twin pregnancies

Ultrasonographic prediction of birth weight discordance in twin pregnancies

Is Growth-Discordance in Twins a Substantial Risk Factor in Adverse Neonatal Outcomes?

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