Authors
Breathnach, Fionnuala MMcAuliffe, 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.ieIssue Date
2011-07Keywords
Birth WeightFemale
Fetal Monitoring
Fetofetal Transfusion
Humans
Pregnancy
Twins /physiology
MeSH
Birth WeightFemale
Fetal Monitoring
Fetofetal Transfusion
Humans
Pregnancy
Pregnancy Outcome
Proportional Hazards Models
Prospective Studies
Twins
Ultrasonography, Prenatal
Metadata
Show full item recordCitation
Definition of intertwin birth weight discordance. 2011, 118 (1):94-103 Obstet GynecolPublisher
OVID Lippincott Williams and WilkinsJournal
Obstetrics and gynecologyDOI
10.1097/AOG.0b013e31821fd208PubMed ID
21691168Abstract
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
ArticleLanguage
enISSN
1873-233Xae974a485f413a2113503eed53cd6c53
10.1097/AOG.0b013e31821fd208
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