First trimester prediction of growth discordance in twin gestations

Kalish, Robin B.; Chasen, Stephen T.; Gupta, Mala; Sharma, Geeta; Perni, Sriram C.; Chervenak, Frank A.

doi:10.1067/s0002-9378(03)00714-2

Cited by 76 publications

(69 citation statements)

References 20 publications

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“…Though clear ethiology is still unclear resulting in growth discordance of twins exposed to the same maternal enviroment, placental and/or fetal factors should determine the background (11) inducing this phenomenon. Twins who are ultimately discordant at birth may exhibit differences in growth as early as 11-14 weeks of gestation (12). Our study provided further evidence that unlike-sex pairs (13) are significantly more prevalent among discordant ART twins.…”

Section: Resultssupporting

confidence: 67%

Birth Weight Discordance in Spontaneous Versus Induced Twins: Impact on Perinatal Outcome

Zádori

Kozinszky

Orvos

et al. 2004

J Assist Reprod Genet

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Purpose : To compare the rate of birth weight discordance and perinatal outcome of twin pregnancies after assisted reproduction with that of spontaneous twins. Method : A total of 12,920 deliveries were analyzed retrospectively. Seventy-five twin pregnancies after ART were compared to the 94 spontaneous counterparts. Birth weight discordance was defined as a difference of 20% or more. Results : Discordance rate was elevated (25.3% vs. 17.0%) among ART twins. SGA was increased and NICU admission was more frequent in discordant group. Unlike-sexed twins were more prevalent (73.7% vs. 37.5%) among discordants after ART. Conclusions : ART can increase discordance rate which can elevate perinatal risk.

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Section: Resultssupporting

confidence: 67%

Birth Weight Discordance in Spontaneous Versus Induced Twins: Impact on Perinatal Outcome

Zádori

Kozinszky

Orvos

et al. 2004

J Assist Reprod Genet

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“…This finding of decreased birth weight predicted by a decreased first-trimester CRL is consistent with the literature. Kalish et al 3 noted that twins who were discordant at birth may have had differences in growth as early as 11 weeks' gestation. Bartha et al 8 found that firsttrimester discordant twins had an increased risk of intrauterine growth restriction and growth discordance later in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…1 Such discrepancies in first-trimester CRL measurements have been associated with chromosomal abnormalities, anatomic malformations, 2 and discordant birth weights. 3 Whether CRL dissimilarity specifically in chromosomally euploid and structurally normal twins is associated with adverse perinatal outcomes is unknown. Tai and Grobman 4 reported an increased incidence of intrauterine growth restriction in at least one of the twin pair with first-trimester discordance above the 85th percentile and significantly increased composite perinatal morbidity.…”

mentioning

confidence: 99%

Discordance of First-Trimester Crown-Rump Length Is a Predictor of Adverse Outcomes in Structurally Normal Euploid Dichorionic Twins

Fareeduddin

Williams

Solt

et al. 2010

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to determine the association between discordant crownrump length (CRL) measurements in structurally normal euploid dichorionic twins and adverse pregnancy outcomes. Methods. This retrospective cohort study included women with dichorionic twins who underwent chorionic villus sampling and delivered in our facility from January 2000 to September 2007. Only pregnancies with viable twin fetuses and normal karyotypes were included. The association between CRL discordance, defined as a CRL discrepancy of 9% or greater, and adverse pregnancy outcomes was evaluated. Results. Seventy-eight women met inclusion criteria and included 24 discordant twins (group 1) and 54 concordant twins (group 2). Maternal ages were similar: mean ± SD, 38.2 ± 3.1 years in group 1 versus 39.2 ± 3.9 years in group 2 (P = not significant). The median gestational ages at delivery were 35.6 ± 3.1 weeks in group 1 and 37.3 ± 2.0 weeks in group 2 (P < .01). At least 1 major complication occurred in 19 women (79%) in group 1 and 25 (46%) in group 2 (P = .01). Group 1 had significantly more major complications overall (P = .0008). Preterm premature rupture of membranes occurred in 10 women (42%) in group 1 and 6 (11%) in group 2 (P = .005). Delivery before 37 weeks' gestation occurred in 19 of 24 women (79%) in group 1 and 24 of 54 (44%) in group 2 (P = .006). There was a significant difference for younger gestational age at delivery in the discordant group (P < .01). Conclusions. Our data suggest that there is an increased risk of adverse pregnancy outcomes in chromosomally normal dichorionic twins with first-trimester discordant CRL measurements. These results may be clinically useful for counseling, management, and antenatal surveillance. Key words: crown-rump length; dichorionic; discordance; prenatal diagnosis; twin. Whether CRL dissimilarity specifically in chromosomally euploid and structurally normal twins is associated with adverse perinatal outcomes is unknown. Tai and Grobman 4 reported an increased incidence of intrauterine growth restriction in at least one of the twin pair with first-trimester discordance above the 85th percentile and significantly increased composite perinatal morbidity. However, the fetal karyotype and stratification of outcome Received March 8, 2010, from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (R.F., J.W., I.S., M.J.K., S.R.), and Division of Biostatistics (J.M.M.), Cedars-Sinai

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“…Kalish et al [30] demonstrated that, twins with birth weight discordance may differ in fetal size as early as at 11-14 weeks of gestation. Furthermore, fetuses with identical CRL measurements are significantly less likely to develop a subsequent growth discrepancy [30].…”

Section: Crown-rump Length Discordance and Perinatal Outcomementioning

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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First trimester prediction of growth discordance in twin gestations

Cited by 76 publications

References 20 publications

Birth Weight Discordance in Spontaneous Versus Induced Twins: Impact on Perinatal Outcome

Birth Weight Discordance in Spontaneous Versus Induced Twins: Impact on Perinatal Outcome

Discordance of First-Trimester Crown-Rump Length Is a Predictor of Adverse Outcomes in Structurally Normal Euploid Dichorionic Twins

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

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