Is Discordant Growth in Twins an Independent Risk Factor for Adverse Neonatal Outcome?

Amaru, Rebecca C.; Bush, Melissa; Berkowitz, Richard L.; Lapinski, Robert; Gaddipati, Sreedhar

doi:10.1097/01.aog.0000104060.37475.29

Cited by 121 publications

(84 citation statements)

References 13 publications

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“…This risk factor or more frequent maternal complications might be the reason for the higher incidence of cesarean delivery in discordant twins. In the studies of Cheung et al 6 and Amaru et al, 23 caesarean delivery rates were higher in highly discordant twins, too.…”

Section: Discussionmentioning

confidence: 86%

“…Patterson et al 22 also found that adverse neonatal outcome was associated with IUGR, birth weight percentile and prematurity, but not discordance. In the study of Amaru et al, 23 discordant twins were at risk for some adverse neonatal outcome like LBW and VLBW birth, NICU admission, neonatal oxygen requirement and hyperbilirubinemia; whether they were AGA or SGA. In that study, discordance did not appear to be an independent risk factor for neither serious neonatal morbidity nor mortality.…”

Section: Discussionmentioning

confidence: 97%

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Does birth weight discordance in preterm twins affect neonatal outcome?

et al. 2006

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Objective: To compare neonatal morbidity and mortality between hospitalized discordant and concordant preterm twin pairs.Study Design: This was a retrospective, hospital-based study of preterm twins, followed in neonatal intensive care unit. Twins were classified as discordant when the difference in birth weight was >15%. Morbidity and mortality rates were compared between discordant and concordant groups.Results: Of 136 preterm twins in the study, 54 were discordant and 82 were concordant. In discordant twins hypoglycemia and cesarean delivery rate was higher than concordant pairs. The mortality rate did not differ between concordant and discordant groups.Conclusions: Hospitalized preterm discordant twin pairs have an increased risk of hypoglycemia compared to concordants. Discordant growth is not a risk factor for prolonged hospitalization and increased mortality.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 97%

Does birth weight discordance in preterm twins affect neonatal outcome?

et al. 2006

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“…Most authors believe that 25% is the difference level above which discordance should be considered as abnormal and might reflect some significant degree of growth restriction (Blickstein & Keith, 2004). Our study evaluates neonatal morbidity and mortality along several degrees of weight discordance in twin pregnancies, excluding cases with associated fetal abnormalities and TTTS that might have biased results of previous investigations (Copperstock et al, 2000;Amaru et al, 2004). We did not find any maternal factor that may be related to discordant growth in twins as it was previously reported (Hartley et al, 2002).…”

Section: Discussionmentioning

confidence: 95%

Is Growth-Discordance in Twins a Substantial Risk Factor in Adverse Neonatal Outcomes?

et al. 2011

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To evaluate whether growth discordance is an independent risk factor in the neonatal outcome of the smaller twin, all medical records of twin pregnancies delivered between 26 and 41 weeks during a 5-year period (January 2004–December 2008) were reviewed. Among the 49 selected twins, weight discordance was 15–20% in 7 infants, 21–30% in 16 infants, 31–40% in 16 infants and > 40% in 10 infants. No significant differences between the four groups were found with regards to obstetric complications and neonatal disease. Occurrence of birthweight below the 10th percentile and rate of admission to the neonatal intensive care unit significantly increased as intra-pair birthweight difference increased (p = .03). The > 40% discordant group had a significantly lower gestational age (p = .03), lower birthweight (p = .007) and a significantly higher mortality rate (4/10 versus 3/39 p = .04) in comparison with the other discordant groups. Multiple logistic regression analysis showed that birthweight was the single independent and consistent factor associated with elevated risks of mortality. For every 250 g increase in birthweight, the risk for mortality decreased by about 84% [RR 0.16(CI 0.00-0.70)]. Gestational age was the most reliable predictor for major neonatal complications. For every 1-week increase in gestational age a significant decreased risk for all outcomes was found. Discordance alone should not be considered as a predictor for adverse neonatal outcome. Neonatal outcome in discordant twins appears to be related to gestational age and birthweight rather than to the degree of discordance.

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“…In retrospective studies the threshold range from 10 to 30% [4,5,9,[19][20][21][22][23][24] (Table 1). According to the American College of Obstetricians and Gynecologists [27] an EFW disparity of approximately 15-25% is considered to be clinically significant, whereas the UK National Institute for Health and Care Excellence guidelines [28] set the threshold at the level of 25% and recommend the referral of such pregnancies to a tertiary fetal medicine center.…”

Section: Estimated Fetal Weight 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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Is Discordant Growth in Twins an Independent Risk Factor for Adverse Neonatal Outcome?

Abstract: Discordance places twins at increased risk for some adverse perinatal outcomes, whether they are AGA or SGA. Discordance was not an independent risk factor for serious neonatal morbidity or mortality; however, this study was underpowered to detect those differences.

Cited by 121 publications

References 13 publications

Does birth weight discordance in preterm twins affect neonatal outcome?

Does birth weight discordance in preterm twins affect neonatal outcome?

Is Growth-Discordance in Twins a Substantial Risk Factor in Adverse Neonatal Outcomes?

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

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