FETAL DISCORDANCY IN MONOCHORIONIC TWINS
Abstract
Objective: to investigate the predictive value of fetal weight discordance as a risk factor associated with adverse perinatal outcomes. Materials and Methods: 55 patients with monochorionic diamniotic twin pregnancies with fetal weight discordancy were analyzed. All patients underwent ultrasound examination in the 1st trimester of pregnancy (11-14 weeks) to confirm the chorionicity. Estimated fetal weight discordance was calculated as (larger estimated fetal weight - smaller estimated fetal weight) / larger estimated fetal weight. All monochorionic patients were divided into the groups according to the differences in birthweight in twins (≤10%, >10 ≤15%, >15 ≤20%, ≤20 ≤25%, >25%). Adverse perinatal outcomes included: preterm delivery rate (≤34 weeks), fetal distress, low Apgar score, perinatal death, pathological neurosonographic findings. Results: severe birthweight discordance (>20%) in our study was associated with the highest risk of prematurity (76.2%), IUGR (47.6%), fetal distress and low Apgar score (75.0%), pathological neurosonographic findings (46.3%). These adverse perinatal outcomes were more pronounced in the group of monochorionic patients with birthweight discordance greater than 25%. Fetal weight discordance (>20%) is associated with the high risk of adverse perinatal outcomes and twin pregnancies with this complication require careful antenatal monitoring and timing of delivery.
About the Authors
L. G. Sichinava
The Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the Russian Federation, Moscow
Russian Federation
Russian Federation
O. B. Panina
Lomonosov Moscow State University
Russian Federation
Russian Federation
K. G. Gamsakhurdiya
Center for Family Planning and Reproductive Health Department of Moscow
Russian Federation
Russian Federation
References
1. Visaitova M.B. During pregnancy and perinatal outcomes in twins. Phd. Diss. [Techenie beremennosti i rodov, perinatal’nye iskhody pri dvoine. Avtoref. diss. …kand. med. nauk]. Moscow. 2003; 26 c.
2. Kalashnikov S.A., Zyablikova R.V., Sichinava L.G. Voprosy ginekologii, akusherstva i perinatologii. 2004; 3 (3): 55-58.
3. Makatsariya N.A. Akusherstvo, ginekologiya i reproduktsiya. 2014; 2: 126-130.
4. Povarova A.A., Sichinava L.G., Bugerenko A.E., Vykhristyuk Yu.V. Vestnik RGMU. 2011; 2 (200): 39-41.
5. Sichinava L.G., Kalashnikov S.A., Panina O.B. Akusherstvo i ginekologiya. 2003; 2: 12-18.
6. Sichinava L.G. Akusherstvo, ginekologiya i reproduktsiya. 2014; 2: 131-138.
7. Ananth C.V., Vintzileos A.M., Shen-Schwartz S. et al. Standards of birth weight in twin gestations stratified by placental chorionicity. Ob. Gyn. 1998; 91: 917-924.
8. Barrett J.F., Ritchie W.K. Twin delivery. Best Pract. Res. Clin. Obstet. Gynaecol. 2002; (16 №1): 43-56.
9. Berghella V., Kaufmann M. Natural history of twin-twin transfusion syndrome. J. Reprod. Med. 2001; 46 (5): 480-484.
10. Clinical maternal-fetal medicine. Edited by H.N.Winn, J.C. Hobbins. Parthenon publishing. 2000; 42, 44.
11. Cordero L., Franco A., Joy S.D. et al. Monochorionic Diamniotic Infants Without Twin-to-Twin Transfusion Syndrome. J. Perinatol. 2005; (25 №12): 753-758.
12. Crombleholme T.M. The treatment of twin-twin transfusion syndrome. Semin. Pediatr. Surg. 2003; (12 №3): 175-181.
13. Ferreira I., Laureano C., Branco M. et al. Chorionicity and adverse perinatal outcome. Acta Med. Port. 2005; (18 №3): 183-188.
14. Fick A.L., Feldstein V.A., Norton M.E. et al. Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins. Am. J. Obstet. Gynecol. 2006; (195 №1): 78-83.
15. Gaziano E.P., De Lia J.E., Kuhlmann R.S. Diamnionic monochorionic twin gestations: an overview. J. Matern. Fetal Med. 2000; (9 №2): 89-96.
16. Gonzalez-Quintero V.H., Luke B., O’Sullivan M.J. et al. Antenatal factors associated with significant birth weight discordancy in twin gestations. Am. J. Obstet. Gynecol. 2003; (189 №3): 813-817.
17. Gratacos E. Selective intrauterine growth restriction in MC twins. The J. of Maternal- Fetal and Neonatal Medicine. 2009; 22: 28.
18. Hanley M.L., Ananth C.V., Shen-Schwarz S. et al. Placental cord insertion and birth weight discordancy in twin gestations. Obstet. Gynecol. 2002; (99 №3): 477-482.
19. Hirtenlehner-Ferber K., Krampl E., Strohmer H. et al. Multiple pregnancy. Ther. Umsch. 2002; (59 №12): 683-688.
20. Imaizumi Y. Perinatal mortality in twins and factors influencing mortality in Japan, 1980-
21. Paediatr. Perinat. Epidemiol. 2001; (15 №3): 298-305.
22. Leduc L., Takser L., Rinfret D. Persistence of adverse obstetric and neonatal outcomes in monochorionic twins after exclusion of disorders unique to monochorionic placentation. Am. J. Obstet. Gynecol. 2005; (193 №5): 1670-1675.
23. Multiple pregnancy. Edited by I. Blickstein, L.G. Keith / Tailor and Francis Group. Parthenon Book. 2nd edition. 2005; p. 514-520.
24. Odibo A.O., Macones G.A. Management of twin-twin transfusion syndrome: laying the foundation for future interventional studies. Twin Res. 2002; (5 №6): 515-520.
25. Rao A., Sairam S., Shehata H. Obstetric complications of twin pregnancies. Best Pract. Res. Clin. Obstet. Gynaecol. 2004; (18 №4): 557-576.
26. Senat M.V., Loizeau S., Couderc S. et al. The value of middle cerebral artery peak systolic velocity in the diagnosis of fetal anemia after intrauterine death of one monochorionic twin. Am. J. Obstet. Gynecol. 2003; 189: 1320-1324.
27. Woo H.N.N., Sin S.Y., Tang L.C.H. Single foetal death in twin pregnancies: review of the maternal and neonatal outcomes and management. Hong Kong Med. J. 2000; 6: 293-300.
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29.
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For citations:
Sichinava L.G., Panina O.B., Gamsakhurdiya K.G. FETAL DISCORDANCY IN MONOCHORIONIC TWINS. Obstetrics, Gynecology and Reproduction. 2015;9(1):6-12. (In Russ.) https://doi.org/10.17749/10.17749/2313-7347.2015.9.1.006-012
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