Advertisement

Preterm discordant twins: What birth weight difference is significant?

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      OBJECTIVE: The purpose of this study was to determine the effect of discordant fatal growth on subsquent perinatal and neonatal outcome for different degrees of birth weight discordance in preterm twin gestations.
      STUDY DESIGN: One hundred twenty-two live born twin sets delivered between 25 and 34 completed weeks' gestation were retrospectively studied. They were stratified into five categories according to the percent different in infant birth weight: <10%, 10% to 15%, 15 to 20%, 20% to 30%, and >30%, which was defined as ([Birth weight of larger twin - Birth weight of smaller twin]/Birth weight of larger twin) × 100. The relationship between different birth weight categories and the perinatal and neonatal outcome and the difference in outcome between the large and small infants within each cateegory were determined.
      RESULTS: Preterm twin gestations with >30% birth weight dicordance were associated with a higher incidence of infant death (25%), congenital anomalies (37.5%), small-for-gestational-age infants (31.8%), Apgar score <7 at 5 minutes (33.3%), and periventricular leukomalacia (16.7%), in spite of a higher cesarean delivery rate (79.2%). Outcomes of large and small infants within categories were similar except in the >30% group, where all deaths occurred in the small infants.
      CONCLUSION: In preterm twin gestations the use of 30% birth weight difference to define twin discordance is most clinically relevant in identifying those infants at risk for adverse perinatal outcome.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rodis JF
        • Vintzileos AM
        • Campbell WA
        • Nochimson DJ
        Intrauterine fetal growth in discordant twin gestations.
        J Ultrasound Med. 1990; 9: 443-448
        • Blickstein I
        • Lancet M
        The growth discordant twin.
        Obstet Gynecol Surv. 1988; 43: 509-515
        • Erkkola R
        • Ala-Mello S
        • Piiroinen O
        • Kero P
        • Sillanpaa M
        Growth discordancy in twin pregnancies: a risk factor not detected by measurements of biparietal diameter.
        Obstet Gynecol. 1985; 66: 203-206
        • Storlazzi E
        • Vintzileos AM
        • Campbell WA
        • Nochimson DJ
        • Weinbaum PJ
        Ultrasonic diagnosis of discordant fetal growth in twin gestations.
        Obstet Gynecol. 1987; 69: 363-367
        • Blickstein I
        • Friedman A
        • Caspi B
        • Lancet M
        Ultrasonic prediction of growth discordancy by intertwin difference in abdominal circumference.
        Int J Gynecol Obstet. 1989; 29: 121-124
        • Eberle AM
        • Levesque D
        • Vintzileos AM
        • Egan JFZ
        • Tsapanos V
        • Salafia CM
        Placental pathology in discordant twins.
        Am J Obstet Gynecol. 1993; 169: 931-935
        • Blickstein I
        • Shoham-Schwartz Z
        • Lancet M
        • Borenstein R
        Characterization of the growth-discordant twin.
        Obstet Gynecol. 1987; 70: 11-15
        • Ballard JL
        • Novak KK
        • Driver MA
        A simplified score for assessment of fetal maturation of newly born infants.
        J Pediatr. 1979; 95: 769-774
        • O'Brodovich HM
        • Mellins RB
        Bronchopulmonary dysplasia.
        in: Unresolved neonatal acute lung injury. 3rd ed. Am Rev Respir Dis. 132. 1985: 694-709
        • Bell MJ
        • Ternberg JL
        • Feigin RD
        • et al.
        Neonatal necrotizing entercolitis.
        in: Therapeutic decisions based upon clinical staging. 3rd ed. Ann Surg. 187. 1978: 1-7
        • Papile LA
        • Burstein J
        • Burstein R
        • Koffler H
        Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infant with birth weights less than 1,500 gm.
        J Pediatr. 1978; 92: 529-534
        • Keen DV
        • Pearse RG
        Weight, length and head circumference curves for boys and girls of between 20 and 42 weeks' gestaion — short report.
        Arch Dis Child. 1988; 63: 1170-1172
        • O'Brien WF
        • Knuppel RA
        • Scarbo JC
        • Rattan PK
        Birth weight in twins: an analysis of discordancy and growth retardation.
        Obstet Gynecol. 1986; 67: 483-486
        • Spellacy WN
        • Handler A
        • Ferre CD
        A case-control study of 1253 twin pregnancies from a 1982–1987 perinatal data base.
        Obstet Gynecol. 1990; 75: 168-171
        • Patterson RM
        • Wood RC
        What is twin birthweight discordance?.
        Am J Perinatal. 1990; 7: 217-219
        • Babson SG
        • Phillips DS
        Growth and development of twins dissimilar in size at birth.
        N Engl J Med. 1973; 289: 937-940
        • Ylitalo V
        • Kero P
        • Erkkola R
        Neurological outcome of twins dissimilar in size at birth.
        Early Hum Dev. 1988; 17: 245-255
        • Blickstein I
        The twin-twin transfusion syndrome.
        Obstet Gynecol. 1990; 76: 714-722
        • Wenstrom KD
        • Tessen JA
        • Zlatnik FJ
        • Sipes SL
        Frequency, distribution, and theoretical mechanisms of hematologic and weight discordance in monochorionic twins.
        Obstet Gynecol. 1992; 80: 257-261