Prediction of Second Trimester Intrauterine Growth Retardation and Fetal Death in a Discordant Twin by First Trimester Measurements

Tadmor, O.; Nitzan, M; Rabinowitz, R.; Skomorovsky, Y.; Aboulafia, Y; Diamant, Yoram Z.

doi:10.1159/000264186

Cited by 8 publications

(4 citation statements)

References 9 publications

(11 reference statements)

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“…Perinatal mortality and morbidity rates for monochorionic twins are increased 3-to 10-fold with a perinatal mortality risk of up to 26%; these twins also have a 2-to 3-fold higher incidence of congenital malformations. 13 Finally, monochorionic twins are at risk for twin-twin transfusion syndrome, which incurs a substantial risk of obstetric complications. Indeed, in the study by Tai and Grobman, 4 the incidence of twin-twin transfusion syndrome in their discordant CRL study population was 43.9%.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Intertwin discrepancy may be an ominous finding with respect to adverse perinatal outcome, including chromosomal abnormalities, structural anomalies, intrauterine growth restriction and fetal death. However, results are controversial32–39. Another interesting population for studying early fetal growth consists of ART pregnancies40, in which gestational age is considered certain.…”

Section: Early Fetal Growth: Conceptsmentioning

confidence: 99%

Early fetal growth: concepts and pitfalls

Salomon

2010

Ultrasound in Obstet & Gyne

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Background: Postpancreatectomy haemorrhage (PPH) is a major cause of morbidity and mortality after pancreaticoduodenectomy (PD). It remains unclear whether performance of a pancreatogastrostomy (PG) instead of a pancreatojejunostomy (PJ) improves outcomes owing to better endoscopic accessibility. Methods: A large retrospective analysis was undertaken to compare outcomes of PPH, depending on whether a PG or PJ was performed. The primary outcome was the rate of successful endoscopy. A secondary outcome was the therapeutic success after adding surgery. Results: Of 944 patients who had a PD, 8·4 per cent developed PPH. Endoscopy was the primary intervention in 21 (81 per cent) of 26 patients with a PG and 34 (64 per cent) of 53 with a PJ; it identified the bleeding site in 35 and 25 per cent respectively (P = 0·347). Successful endoscopic treatment was more common in the PG group (31 versus 9 per cent; P = 0·026). Surgery was performed for PPH in 15 patients (58 per cent) with a PG and 35 (66 per cent) with a PJ (P = 0·470). The majority of haemorrhages that required surgery were non‐anastomotic intra‐abdominal haemorrhages (12 of 15 versus 21 of 35; P = 0·171). Endoscopic or conservative treatment for PPH was successful in 42 per cent of patients with a PG and 32 per cent with a PJ (P = 0·520). The success rate increased to 85 and 91 per cent respectively when surgery was included in the algorithm (P = 0·467). Conclusion: The type of pancreatic anastomosis and its inherent effect on endoscopic accessibility had very little impact on the outcome of PPH. This was because haemorrhage frequently occurred from intra‐abdominal or non‐anastomotic intraluminal lesions. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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“…The second case was a dichorionic twin pregnancy achieved by donor insemination, where discrepancy in fetal growth was first noted at nine weeks 2 . By 19 weeks the smaller twin had oligohydramnios and elevated umbilical artery resistance.…”

Section: Discussionmentioning

confidence: 99%