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Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins

Authors
  • Ashwal, Eran
  • Hiersch, Liran
  • Berger, Howard
  • Aviram, Amir
  • Zaltz, Arthur
  • Kingdom, John
  • Barrett, Jon
  • Melamed, Nir
Type
Published Article
Journal
Fetal Diagnosis and Therapy
Publisher
S. Karger AG
Publication Date
Mar 29, 2021
Volume
48
Issue
4
Pages
279–287
Identifiers
DOI: 10.1159/000514328
PMID: 33780952
Source
Karger
Keywords
License
Green
External links

Abstract

Objective: The aim of the current study was to identify the optimal cutoff that should define discordance in dichorionic twin gestations through correlation with abnormal placental pathology as a specific measure of fetal growth restriction of the smaller twin. Methods: We performed a retrospective cohort study of all women with dichorionic twin pregnancies who gave birth in a single center between 2002 and 2015. We investigated the association between the level of growth discordance and maternal vascular malperfusion (MVM) pathology in the placenta of the smaller twin, with and without adjustment for whether the smaller twin is small for gestational age (SGA). Results: A total of 1,198 women with dichorionic twin gestation met the study criteria. The rate of MVM pathology in the placenta of the smaller twin increased with the level of discordance and was most obvious for discordance ≥25% (rate of MVM 12.0% compared with 2.8% in cases with discordance <10%, adjusted relative risk [aRR] 3.71, 95% confidence interval [CI] 1.97–6.99). When the analysis was adjusted for SGA of the smaller twin, discordance was independently associated with MVM pathology only when growth discordance was ≥25% (aRR 2.18, 95%-CI 1.01–4.93), while SGA was strongly associated with MVM pathology irrespective of the level of discordance. Conclusion: Our findings suggest that discordant growth in dichorionic twins should raise the concern of fetal growth restriction of the smaller twin, irrespective of whether the smaller twin is SGA, only when the discordance s ≥25%. The association of lower levels of discordance with abnormal placental pathology is mainly driven by the confounding effect of SGA of the smaller twin.

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