The aim of the study was to determine the effect of the displacement of the umbilical cord insertion site from the centre of the placenta on the placental mass and the birth weight of dichorionic diamniotic twins and to consider the importance of the direction of the displacement, as well as to assess the influence of the umbilical cord displacement on the placental mass and the birth weight of dichorionic diamniotic twins taking into account the direction of displacement. Material and methods. The study was performed on 135 dichorionic diamniotic pairs: 68 opposite-sex, 35 same-sex males, and 32 same-sex females. The impact of an absolute cord displacement from the centroid of the placental disc and the direction of its shifting were compared with the birth weight and the placental mass. Results. In the investigated group, a central insertion was revealed in 6 (2.2 %), eccentric – in 224 (83.0 %), marginal – in 31 (11.5 %), and velamentous – in 9 (3.3 %) cases. The first two types of cord insertion are considered to be normal, the third and the fourth are seen as abnormal. The placental mass was in a strong positive correlation with the birth weight (r=0.71, p<0.0001). The placentas with an eccentric cord insertion had a smaller surface area. A negative correlation was established between the displacement of the cord insertion site and the placental mass (r=-0.4284, p<0.0001) as well as the birth weight (r=-0.6115, p<0.0001). The shift along the long axis was of greater importance than in relation to the shorter one. The placental mass and the birth weight were higher in the new-borns with a normal cord insertion site. In the abnormal cord insertion group, 32.5 % of the infants were under the 10th birth weight percentile, in the normal cord insertion group – only 8.3 %. Conclusions. The birth weight of dichorionic diamniotic twins and their placental mass are negatively correlated with the distance of the umbilical cord insertion site from the placental centre. The insertion site displacement along the long axis has a stronger negative effect on the birth weight and the placental mass in comparison with the shifting along the short axis. The placentas with an eccentric cord insertion have a smaller surface area.
The relevance of the study lies in the significant increase in multiple pregnancies connected with the higher risk of perinatal complications, the controversy over the effects of chorionicity and sex of the babies on their birth weight, the need for timely diagnosis of fetal growth restriction, and associated morbidity. The objective of this study was to compare fetal weights at the birth of different variants of twins depending on chorionicity, gestational age, and sex. Materials and methods. During 2016-2020, 440 pairs of twins were examined: 375 dichorionic diamniotic and 65 monochorionic diamniotic (38 – boys, 27 – girls). Among dichorionic couples there were 186 (49.6%) opposite-sex, 98 (26.1%) same-sex males and 91 (24.3%) same-sex females. Fetal weight was measured at birth, and its relationship to chorionicity, fetal sex, a combination of same-sex or opposite-sex co-twins, and gestational age was assessed. Results. The average weight of 750 fetuses from dichorionic pairs (2570.0 ± 506.43 g) significantly exceeded the weight of 130 fetuses from monochorionic pairs (2333.4 ± 567.24 g, p < 0.0001). The same-sex male (2603.8 ± 532.29 g) and opposite-sex dichorionic diamniotic (2595.6 ± 490.17 g). twins’ masses significantly surpassed the mass of all other twins (p <0.05). In the group of dichorionic twins, the weight of boys exceeded the weight of girls (2638.1 ± 525.96 g vs. 2499.4 ± 475.84 g, p = 0.0002). This pattern was observed both inside the opposite-sex pairs (2674.2 ± 518.17 g vs. 2517.1 ± 448.24 g, p = 0.0019), and same-sex couples of boys compared to same-sex couples of girls (2603.8 ± 532.29 g and 2481.4 ± 503.08 g, respectively, p = 0.0224). No significant difference in the weight of girls of opposite-sex twins compared to same-sex couples was seen. In monochorionic pairs, the weight of male and female fetuses did not differ significantly. Birth weight discordance was found in all types of twins, the highest percentage of discordance was registered in monochorionic boys – 23.7%, second place in frequency took male dichorionic twins – 20.4%. Among the 30 discordant dichorionic opposite-sex twins in 19 (63.3%) cases, the male fetus was heavier. There was no significant difference in fetal weight when women were fertilized naturally and using assisted reproductive technologies. The average weight of children born by surrogate mothers exceeded the weight of children born by non-surrogate mothers (p = 0.0466). In the first pregnancy, children were born with a lower body weight compared to children born as a result of repeated pregnancies and in women who had a history of childbirth. Conclusion. The average weight of the fetuses of dichorionic twins was higher than the weight of the neonates f monochorionic pairs. The prevalence of the weight of boys over the weight of girls from dichorionic pairs and the absence of sex difference in fetal weight in monochorionic twins indicates the possibility of different functional activity of the placenta in fetuses of different sexes. Small for gestational age newborns were most often found in the group of female monochorionic twins and opposite-sex dichorionic pairs. Discordance of fetal mass was most common in monochorionic same-sex male twins. In discordant opposite-sex couples, the male fetus more often was heavier. There was no significant difference in newborn weight when women were fertilized naturally and with the use of assisted reproductive technologies. The average weight of surrogate-born children exceeded the weight of children born by non-surrogate mothers. In the first pregnancy, children were born with a lower body weight compared to children of multiparous and multigravida women.
ТКАЧЕНКО А.В., ТЕПЛА І.В. Національна академія післядипломної освіти імені П.Л. Шупика, кафедра акушерства та гінекології ¹1, м.Київ ОСОБЛИВОСТІ ПЕРЕБІГУ ВАГІТНОСТІ ТА СТАНУ НОВОНАРОДЖЕНИХ ПРИ ДВІЙНЯХ З РІЗНИМИ ФОРМАМИ ПЛАЦЕНТАЦІЇ.Багатоплідна вагітність (БВ) у людини зустрічається в 0,7-4,0% випадків. Частота народження монозиготних двійнят стабільна у представників різних рас -приблизно 4 на 1000 пологів. В той же час спостерігається суттєва варіабельність у кількості дизиготних двієнь в різних расових групах. Такі вагітності в 10 разів частіше у порівнянні із одноплідними завершуються передчасно, що збільшує частоту передчасних пологів і підвищує ризик неонатальної та малюкової смертності. Відомо, що вагітності двійнями незалежно від способу запліднення (спонтанне або з використанням ДРТ) пов'язані з підвищеним акушерським та перинатальним ризиком, включаючи більшу частоту мертвонароджень. Отже, вагітні з БВ потребують особливого підходу до антенатального спостереження, акушерської тактики, обрання терміну та методів розродження з метою прогнозування, своєчасної діагностики та попередження найбільш поширених акушерських та перинатальних ускладнень. Найбільш суттєвим факторами, що впливають на перебіг двоплідної вагітності та здебільшого зумовлюють її прогноз є хоріальність та ранні прояви специфічних (СБП) та неспецифічних (МГВП/ЗВУР) ускладнень. Водночас, в літературних джерелах існують лише поодинокі дані щодо репродуктивного анамнезу, особливостей формування плодово-плацентарного комплексу, перебігу вагітності та пологів і неонатальних наслідків у жінок з різностатевими двійнями, а також прогнозування та діагностики специфічних та неспецифічних гестаційних ускладнень у таких пацієнток. Проведення наукового пошуку в цьому напрямку може представляти суттєвий науковий та практичний інтерес.Ключові слова: дихоріальні двійні, монохоріальні двійні, різностатеві двійні, одностатеві двійні.
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