Definition of intertwin birth weight discordance.

Hdl Handle:
http://hdl.handle.net/10147/208186
Title:
Definition of intertwin birth weight discordance.
Authors:
Breathnach, Fionnuala M; McAuliffe, Fionnuala M; Geary, Michael; Daly, Sean; Higgins, John R; Dornan, James; Morrison, John J; Burke, Gerard; Higgins, Shane; Dicker, Patrick; Manning, Fiona; Mahony, Rhona; Malone, Fergal D
Affiliation:
Royal College of Surgeons in Ireland, UCD School of Medicine and Medical Science, University College Dublin, Ireland. fbreathnach@rcsi.ie
Citation:
Definition of intertwin birth weight discordance. 2011, 118 (1):94-103 Obstet Gynecol
Publisher:
OVID Lippincott Williams and Wilkins
Journal:
Obstetrics and gynecology
Issue Date:
Jul-2011
URI:
http://hdl.handle.net/10147/208186
DOI:
10.1097/AOG.0b013e31821fd208
PubMed ID:
21691168
Abstract:
To establish the level of birth weight discordance at which perinatal morbidity increases in monochorionic and dichorionic twin pregnancy.; This prospective multicenter cohort study included 1,028 unselected twin pairs recruited over a 2-year period. Participants underwent two weekly ultrasonographic surveillance from 24 weeks of gestation with surveillance of monochorionic twins two-weekly from 16 weeks. Analysis using Cox proportional hazards compared a composite measure of perinatal morbidity (including any of the following: mortality, respiratory distress syndrome, hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, or sepsis) at different degrees of birth weight discordance with adjustment for chorionicity, gestational age, twin-twin transfusion syndrome, birth order, gender, and growth restriction.; Perinatal outcome data were recorded for 977 patients (100%) who continued the study with both fetuses alive beyond 24 weeks, including 14 cases of twin-twin transfusion syndrome. Adjusting for gestation at delivery, twin order, gender, and growth restriction, perinatal mortality, individual morbidity, and composite perinatal morbidity were all seen to increase with birth weight discordance exceeding 18% for dichorionic pairs (hazard ratio 2.2, 95% confidence interval [CI] 1.6-2.9, P<.001) and 18% for monochorionic twins without twin-twin transfusion syndrome (hazard ratio 2.6, 95% CI 1.6-4.3, P<.001). A minimum twofold increase in risk of perinatal morbidity persisted even when both twin birth weights were appropriate for gestational age.; : The threshold for birth weight discordance established by this prospective study is 18% both for dichorionic twin pairs and for monochorionic twins without twin-twin transfusion syndrome. This threshold is considerably lower than that defined by many retrospective series as pathologic. We suggest that an anticipated difference of 18% in birth weight should prompt more intensive fetal monitoring.
Item Type:
Article
Language:
en
Description:
Abstract OBJECTIVE: To establish the level of birth weight discordance at which perinatal morbidity increases in monochorionic and dichorionic twin pregnancy. METHODS: This prospective multicenter cohort study included 1,028 unselected twin pairs recruited over a 2-year period. Participants underwent two weekly ultrasonographic surveillance from 24 weeks of gestation with surveillance of monochorionic twins two-weekly from 16 weeks. Analysis using Cox proportional hazards compared a composite measure of perinatal morbidity (including any of the following: mortality, respiratory distress syndrome, hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, or sepsis) at different degrees of birth weight discordance with adjustment for chorionicity, gestational age, twin-twin transfusion syndrome, birth order, gender, and growth restriction. RESULTS: Perinatal outcome data were recorded for 977 patients (100%) who continued the study with both fetuses alive beyond 24 weeks, including 14 cases of twin-twin transfusion syndrome. Adjusting for gestation at delivery, twin order, gender, and growth restriction, perinatal mortality, individual morbidity, and composite perinatal morbidity were all seen to increase with birth weight discordance exceeding 18% for dichorionic pairs (hazard ratio 2.2, 95% confidence interval [CI] 1.6-2.9, P<.001) and 18% for monochorionic twins without twin-twin transfusion syndrome (hazard ratio 2.6, 95% CI 1.6-4.3, P<.001). A minimum twofold increase in risk of perinatal morbidity persisted even when both twin birth weights were appropriate for gestational age. CONCLUSION: : The threshold for birth weight discordance established by this prospective study is 18% both for dichorionic twin pairs and for monochorionic twins without twin-twin transfusion syndrome. This threshold is considerably lower than that defined by many retrospective series as pathologic. We suggest that an anticipated difference of 18% in birth weight should prompt more intensive fetal monitoring.
Keywords:
Birth Weight; Female; Fetal Monitoring; Fetofetal Transfusion; Humans; Pregnancy; Twins /physiology
MeSH:
Birth Weight; Female; Fetal Monitoring; Fetofetal Transfusion; Humans; Pregnancy; Pregnancy Outcome; Proportional Hazards Models; Prospective Studies; Twins; Ultrasonography, Prenatal
ISSN:
1873-233X

Full metadata record

DC FieldValue Language
dc.contributor.authorBreathnach, Fionnuala Men
dc.contributor.authorMcAuliffe, Fionnuala Men
dc.contributor.authorGeary, Michaelen
dc.contributor.authorDaly, Seanen
dc.contributor.authorHiggins, John Ren
dc.contributor.authorDornan, Jamesen
dc.contributor.authorMorrison, John Jen
dc.contributor.authorBurke, Gerarden
dc.contributor.authorHiggins, Shaneen
dc.contributor.authorDicker, Patricken
dc.contributor.authorManning, Fionaen
dc.contributor.authorMahony, Rhonaen
dc.contributor.authorMalone, Fergal Den
dc.date.accessioned2012-02-01T14:51:47Z-
dc.date.available2012-02-01T14:51:47Z-
dc.date.issued2011-07-
dc.identifier.citationDefinition of intertwin birth weight discordance. 2011, 118 (1):94-103 Obstet Gynecolen
dc.identifier.issn1873-233X-
dc.identifier.pmid21691168-
dc.identifier.doi10.1097/AOG.0b013e31821fd208-
dc.identifier.urihttp://hdl.handle.net/10147/208186-
dc.descriptionAbstract OBJECTIVE: To establish the level of birth weight discordance at which perinatal morbidity increases in monochorionic and dichorionic twin pregnancy. METHODS: This prospective multicenter cohort study included 1,028 unselected twin pairs recruited over a 2-year period. Participants underwent two weekly ultrasonographic surveillance from 24 weeks of gestation with surveillance of monochorionic twins two-weekly from 16 weeks. Analysis using Cox proportional hazards compared a composite measure of perinatal morbidity (including any of the following: mortality, respiratory distress syndrome, hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, or sepsis) at different degrees of birth weight discordance with adjustment for chorionicity, gestational age, twin-twin transfusion syndrome, birth order, gender, and growth restriction. RESULTS: Perinatal outcome data were recorded for 977 patients (100%) who continued the study with both fetuses alive beyond 24 weeks, including 14 cases of twin-twin transfusion syndrome. Adjusting for gestation at delivery, twin order, gender, and growth restriction, perinatal mortality, individual morbidity, and composite perinatal morbidity were all seen to increase with birth weight discordance exceeding 18% for dichorionic pairs (hazard ratio 2.2, 95% confidence interval [CI] 1.6-2.9, P<.001) and 18% for monochorionic twins without twin-twin transfusion syndrome (hazard ratio 2.6, 95% CI 1.6-4.3, P<.001). A minimum twofold increase in risk of perinatal morbidity persisted even when both twin birth weights were appropriate for gestational age. CONCLUSION: : The threshold for birth weight discordance established by this prospective study is 18% both for dichorionic twin pairs and for monochorionic twins without twin-twin transfusion syndrome. This threshold is considerably lower than that defined by many retrospective series as pathologic. We suggest that an anticipated difference of 18% in birth weight should prompt more intensive fetal monitoring.en
dc.description.abstractTo establish the level of birth weight discordance at which perinatal morbidity increases in monochorionic and dichorionic twin pregnancy.-
dc.description.abstractThis prospective multicenter cohort study included 1,028 unselected twin pairs recruited over a 2-year period. Participants underwent two weekly ultrasonographic surveillance from 24 weeks of gestation with surveillance of monochorionic twins two-weekly from 16 weeks. Analysis using Cox proportional hazards compared a composite measure of perinatal morbidity (including any of the following: mortality, respiratory distress syndrome, hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, or sepsis) at different degrees of birth weight discordance with adjustment for chorionicity, gestational age, twin-twin transfusion syndrome, birth order, gender, and growth restriction.-
dc.description.abstractPerinatal outcome data were recorded for 977 patients (100%) who continued the study with both fetuses alive beyond 24 weeks, including 14 cases of twin-twin transfusion syndrome. Adjusting for gestation at delivery, twin order, gender, and growth restriction, perinatal mortality, individual morbidity, and composite perinatal morbidity were all seen to increase with birth weight discordance exceeding 18% for dichorionic pairs (hazard ratio 2.2, 95% confidence interval [CI] 1.6-2.9, P<.001) and 18% for monochorionic twins without twin-twin transfusion syndrome (hazard ratio 2.6, 95% CI 1.6-4.3, P<.001). A minimum twofold increase in risk of perinatal morbidity persisted even when both twin birth weights were appropriate for gestational age.-
dc.description.abstract: The threshold for birth weight discordance established by this prospective study is 18% both for dichorionic twin pairs and for monochorionic twins without twin-twin transfusion syndrome. This threshold is considerably lower than that defined by many retrospective series as pathologic. We suggest that an anticipated difference of 18% in birth weight should prompt more intensive fetal monitoring.-
dc.language.isoenen
dc.publisherOVID Lippincott Williams and Wilkinsen
dc.subjectBirth Weighten
dc.subjectFemaleen
dc.subjectFetal Monitoringen
dc.subjectFetofetal Transfusionen
dc.subjectHumansen
dc.subjectPregnancyen
dc.subjectTwins /physiologyen
dc.subject.meshBirth Weight-
dc.subject.meshFemale-
dc.subject.meshFetal Monitoring-
dc.subject.meshFetofetal Transfusion-
dc.subject.meshHumans-
dc.subject.meshPregnancy-
dc.subject.meshPregnancy Outcome-
dc.subject.meshProportional Hazards Models-
dc.subject.meshProspective Studies-
dc.subject.meshTwins-
dc.subject.meshUltrasonography, Prenatal-
dc.titleDefinition of intertwin birth weight discordance.en
dc.typeArticleen
dc.contributor.departmentRoyal College of Surgeons in Ireland, UCD School of Medicine and Medical Science, University College Dublin, Ireland. fbreathnach@rcsi.ieen
dc.identifier.journalObstetrics and gynecologyen
dc.description.provinceLeinster-

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