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Significance of Growth Discordance in Appropriately Grown Twins.
MedLine Citation:
PMID:  23369936     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To determine the perinatal risks associated with growth discordance in appropriately grown twin gestations. STUDY DESIGN: Retrospective cohort study of all twin gestations excluding those complicated by monoamnionicity, twin-twin transfusion syndrome, structural anomalies, selective reduction, or a birth weight <10(th) percentile. Growth discordance was defined as ≥20%. Outcomes considered were stillbirth, preterm delivery <34 weeks and <28 weeks, and admission to the neonatal intensive care unit. Analyses were stratified by chorionicity. RESULTS: Of 895 included dichorionic pregnancies, 63 (7.0%) were discordant. Discordant dichorionic twins were not at increased risk of preterm delivery <34 weeks (34.9% vs 25.6%, relative risk (RR) 1.4, 95% confidence interval (CI) 1.0-1.9), preterm delivery <28 weeks (3.2% vs 2.8%, RR 1.1, 95% CI 0.3-4.8), or admission to intensive care (26.9% vs 23.5%, RR 1.5, 95% CI 1.0-2.3). We had > 90% power to detect a 2.5-fold increase in preterm delivery and admission to the neonatal intensive care unit in dichorionic twins. Of 250 monochorionic pregnancies, 23 (9.2%) were discordant. Monochorionic twin pregnancies were at increased risk of preterm delivery <34 weeks (65.2% vs 26.4%, RR 2.5, 95% CI 1.7-3.6) preterm delivery <28 weeks (34.8% vs 4.0%, RR 8.8, 95% CI 3.7-20.5) and admission to intensive care (68.2% vs 23.3%, RR 2.9, 95% CI 2.0-4.3). CONCLUSIONS: In appropriately grown twins, growth discordance is a risk factor for adverse perinatal outcomes in monochorionic, but not dichorionic, twins. Discordant monochorionic twins may benefit from increased antenatal surveillance.
Authors:
Lorie M Harper; Matthew A Weis; Anthony O Odibo; Kimberly A Roehl; George A Macones; Alison G Cahill
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-28
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  -     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Mosby, Inc. All rights reserved.
Affiliation:
The University of Alabama at Birmingham, Department of Obstetrics and Gynecology. Electronic address: lmharper@uabmc.edu.
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