Discordant twins: Diagnosis, evaluation and management

American Journal of Obstetrics and Gynecology

Volumn 206, Issue 1, 2012, Pages 10-20

  Miller, Jena ^a   Chauhan, Suneet P ^a   Abuhamad, Alfred Z ^a  

^a EASTERN VIRGINIA MEDICAL SCHOOL   (United States)

Author keywords

chorionicity; discordance; discordant twins

Indexed keywords

ARTICLE; BIRTH WEIGHT; CALCIFICATION; CHILDBIRTH; CHORION; CLINICAL CLASSIFICATION; CLINICAL EVALUATION; CROWN RUMP LENGTH; CYTOMEGALOVIRUS INFECTION; EFFUSION; EVIDENCE BASED MEDICINE; FETUS ECHOGRAPHY; FETUS RISK; FETUS WEIGHT; GESTATIONAL AGE; HEALTH CARE MANAGEMENT; HIGH RISK PATIENT; HUMAN; INTRAPARTUM CARE; INTRAUTERINE GROWTH RETARDATION; INTRAUTERINE INFECTION; NEWBORN MORBIDITY; NEWBORN MORTALITY; PLACENTA PREVIA; PRACTICE GUIDELINE; PRENATAL DIAGNOSIS; PREVALENCE; PRIORITY JOURNAL; PROBABILITY; SECOND TRIMESTER PREGNANCY; SENSITIVITY ANALYSIS; SEX DIFFERENCE; SOLUTIO PLACENTAE; THIRD TRIMESTER PREGNANCY; TWIN DISCORDANCE; UNITED STATES;

EID: 84455189487     PISSN: 00029378     EISSN: 10976868     Source Type: Journal    
DOI: 10.1016/j.ajog.2011.06.075     Document Type: Review

References (108)

1. American College of Obstetricians and Gynecologists Multiple gestation: complicated twin, triplet and higher order multifetal pregnancy ACOG practice bulletin no. 56 2004 The College Washington, DC (reaffirmed 2009)
2. The Society of Obstetrician Gynecologists of Canada consensus statement Management of twin pregnancies (part 1); no. 91, July 2000 http://www.sogc.org/ guidelines/public/91E-CONS1-July2000.pdf Accessed July 1, 2010
3. W.J. Watson, F.A. Valea, J.W. Seeds Sonographic evaluation of growth discordance and chorionicity in twin gestation Am J Perinatol 8 1991 342 344
4. A.M. Eberle, D. Levesque, A.M. Vintzileos, J.F. Egan, V. Tsapanos, C.M. Salafia Placental pathology in discordant twins Am J Obstet Gynecol 169 1993 931 935
5. O.H. Jensen, H. Jenssen Prediction of fetal weights in twins Acta Obstet Gynecol Scand 74 1995 177 180
6. V.Y. Cheung, A.D. Bocking, O.P. Dasilva Preterm discordant twins: what birth weight difference is significant? Am J Obstet Gynecol 172 1995 955 959
7. I. Blickstein, M. Manor, R. Levi, R. Goldchmit Is intertwin birth weight discordance predictable? Gynecol Obstet Invest 42 1996 105 108
8. H.R. Yalin, C.G. Zorlu, A. Lembet, S. Ozden, O. Gökmen The significance of birth weight difference in discordant twins: a level to standardize? Acta Obstet Gynecol Scand 77 1998 28 31
9. L.M. Hollier, D.D. McIntire, K.J. Leveno Outcome of twin pregnancies according to intrapair birth weight differences Obstet Gynecol 94 1999 1006 1010
10. W.A. Grobman, B.V. Parilla Positive predictive value of suspected growth aberration in twin gestations Am J Obstet Gynecol 181 1999 1139 1141
11. D.L. Foley, M.C. Neale, K.S. Kendler Does intra-uterine growth discordance predict differential risk for adult psychiatric disorder in a population-based sample of monozygotic twins? Psychiatr Genet 10 2000 1 8
12. K. Demissie, C.V. Ananth, J. Martin, M.L. Hanley, M.F. MacDorman, G.G. Rhoads Fetal and neonatal mortality among twin gestations in the United States: the role of intrapair birth weight discordance Obstet Gynecol 100 2002 474 480
13. R.B. Kalish, S.T. Chasen, M. Gupta, G. Sharma, S.C. Perni, F.A. Chervenak First trimester prediction of growth discordance in twin gestations Am J Obstet Gynecol 189 2003 706 709
14. A.M. Branum, K.C. Schoendorf The effect of birth weight discordance on twin neonatal mortality Obstet Gynecol 101 2003 570 574
15. S. Sannoh, K. Demissie, B. Balasubramanian, G.G. Rhoads Risk factors for intrapair birth weight discordance in twins J Matern Fetal Neonatal Med 13 2003 230 236
16. N. Smiljan Severinski, O. Mamula, O. Petrovic Neonatal outcome in discordant eutrophic twins: twin growth Int J Gynaecol Obstet 86 2004 16 21
17. R.C. Amaru, M.C. Bush, R.L. Berkowitz, R.H. Lapinski, S. Gaddipati Is discordant growth in twins an independent risk factor for adverse neonatal outcome? Obstet Gynecol 103 2004 71 76
18. S.P. Chauhan, D. Shields, D. Parker, M. Sanderson, J.A. Scardo, E.F. Magann Detecting fetal growth restriction or discordant growth in twin gestation stratified by placental chorionicity J Reprod Med 49 2004 279 284
19. I.M. Usta, T.S. Harb, J.B. Rechdan, F.G. Suidan, A.H. Nassar The small-for-gestational-age twin: blessing or curse? J Reprod Med 50 2005 491 495
20. H. Tan, S.W. Wen, K. Fung Kee Fung, M. Walker, K. Demissie The distribution of intra twin birth weight discordance and its association with total twin birthweight, gestational age, and neonatal mortality Eur J Obstet Gynecol Reprod Biol 121 2005 27 33
21. E.V. Kontopoulos, C.V. Ananth, J.C. Smulian, A.M. Vintzileos The influence of mode of delivery on twin neonatal mortality in the US: variance by birth weight discordance Am J Obstet Gynecol 192 2005 252 256
22. S.W. Wen, K.F. Fung, L. Huang Fetal and neonatal mortality among twin gestations in a Canadian population: the effect of intrapair birthweight discordance Am J Perinatol 22 2005 279 286
23. B.A. Armson, C. O'Connell, V. Persad, K.S. Joseph, D.C. Young, T.F. Baskett Determinants of perinatal mortality and serious neonatal morbidity in the second twin Obstet Gynecol 108 2006 556 564
24. Y.L. Chang, T.C. Chang, S.D. Chang Sonographic prediction of significant intertwin birth weight discordance Eur J Obstet Gynecol Reprod Biol 127 2006 35 40
25. F.E. Canpolat, M. Yurdakök, A. Korkmaz, S. Yigit, G. Tekinalp Birthweight discordance in twins and the risk of being heavier for respiratory distress syndrome Twin Res Hum Genet 9 2006 659 663
26. W. Pongpanich, D. Borriboonhirunsarn Prevalence and associated factors of discordant twins in Siriraj Hospital J Med Assoc Thai 89 2006 283 288
27. J. Tai, W.A. Grobman The association of crown-rump length discordance in twin gestations with adverse perinatal outcomes Am J Obstet Gynecol 197 2007 369.e1 369.e4
28. V. Belogolovkin, L. Ferrara, E. Moshier, M. Gandhi, K. Eddleman, J. Stone Differences in fetal growth, discordancy, and placental pathology in reduced versus nonreduced twins Am J Perinatol 24 2007 575 579
29. C. Appleton, L. Pinto, M. Centeno, N. Clode, C. Cardoso, L.M. Graa Near term twin pregnancy: clinical relevance of weight discordance at birth J Perinat Med 35 2007 62 66
30. K.E. Hack, J.B. Derks, S.G. Elias Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study BJOG 115 2008 58 67
31. C.L. Banks, S.M. Nelson, P. Owen First and third trimester ultrasound in the prediction of birthweight discordance in dichorionic twins Eur J Obstet Gynecol Reprod Biol 138 2008 34 38
32. U.S. Nawab, J.S. Greenspan, S. Kirkby, J.F. Culhane, M. Kornhauser Differences in short term neonatal outcomes between discordant twins Adv Neonatal Care 8 2008 334 342
33. C. Alam Machado Rde, L. Brizot Mde, A.W. Liao, V.L. Krebs, M. Zugaib Early neonatal morbidity and mortality in growth-discordant twins Acta Obstet Gynecol Scand 88 2009 167 171
34. M.S. Cooperstock, R. Tummaru, J. Bakewell, W. Schramm Twin birthweight discordance and risk of preterm birth Am J Obstet Gynecol 183 2000 63 67
35. H.R. Yalin, C.G. Zorlu, A. Lembet, S. Ozden, O. Gökmen The significance of birth weight difference in discordant twins: a level to standardize? Acta Obstet Gynecol Scand 77 1998 28 31
36. E. Storlazzi, A.M. Vintzileos, W.A. Campbell, D.J. Nochimson, P.J. Weinbaun Ultrasonic diagnosis of discordant fetal growth in twin gestation Obstet Gynecol 69 1987 363 367
37. J.F. Rodis, A.M. Vintzileos, W.A. Campbell, D.J. Nochimson Intrauterine fetal growth in discordant twin gestations J Ultrasound Med 9 1990 443 448
38. L.M. Hill, D. Guzick, P. Chenevey, D. Boyles, P. Nedzesky The sonographic assessment of twin growth discordancy Obstet Gynecol 84 1994 501 504
39. P. Chamberlain, M. Murphy, F.R. Comerford How accurate is the antenatal sonographic identification of discordant birthweight in twins? Eur J Obstet Gynecol Reprod Biol 40 1991 91 96
40. J.W. Caravello, S.P. Chauhan, J.C. Morrison, E.F. Magann, J.N. Martin Jr, L.D. Devoe Sonographic examination does not predict twin growth discordance accurately Obstet Gynecol 89 1997 529 533
41. P.R. Gernt, J.G. Mauldin, R.B. Newman, V.L. Durkalski Sonographic prediction of twin birth weight discordance Obstet Gynecol 97 2001 53 56
42. S.L. Klam, D. Rinfret, L. Leduc Prediction of growth discordance in twins with the use of abdominal circumference ratios Am J Obstet Gynecol 192 2005 247 251
43. S.P. Chauhan, N.W. Hendrix, E.F. Magann, J.C. Morrison, J.A. Scardo, V. Berghella A review of sonographic estimate of fetal weight: vagaries of accuracy J Matern Fetal Neonatal Med 18 2005 211 220
44. American College of Obstetricians and Gynecologists Intrauterine growth restriction: ACOG Practice Bulletin, No.: 12 2000 The College Washington (DC) (reaffirmed 2008)
45. R. Jaeschke, G.H. Guyatt, D.L. Sackett Evidence-Based Medicine Working Group Users' guide to the medical literature III: how to use an article about a diagnostic test B. What are the results and will they help me in caring for my patients? JAMA 271 1994 703 707
46. J. Zádori, Z. Kozinszky, H. Orvos, M. Katona, S.G. Kaáli, A. Pál Birth weight discordance in spontaneous versus induced twins: impact on perinatal outcome J Assist Reprod Genet 21 2004 85 88
47. I. Blickstein, R.D. Goldman, R. Mazkereth Adaptive growth restriction as a pattern of birth weight discordance in twin gestations Obstet Gynecol 96 2000 986 990
48. J. Hardin, S.L. Carmichael, S. Selvin, E.J. Lammer, G.M. Shaw Increased prevalence of cardiovascular defects among 56,709 California twin pairs Am J Med Genet 149A 2009 877 886
49. S.W. Wen, H. Tan, Q. Yang, M. Walker Prediction of intra-twin birth weight discordance by binary logistic regression analysis Gynecol Obstet Invest 62 2006 186 192
50. K.J. Lee, J. Hur, J. Yoo Twin weight discordance and maternal weight gain in twin pregnancies Int J Gynaecol Obstet 96 2007 176 180
51. A. Victoria, G. Mora, F. Arias Perinatal outcome, placental pathology, and severity of discordance in monochorionic and dichorionic twins Obstet Gynecol 97 2001 310 315
52. I. Blickstein, A. Weissman Birthweight discordancy in male-first and female-first pairs of unlike-sexed twins Am J Obstet Gynecol 162 1990 661 663
53. T. Lazzarotto, L. Gabrielli, M.P. Foschini Congenital cytomegalovirus infection in twin pregnancies: viral load in the amniotic fluid and pregnancy outcome Pediatrics 112 2003 e153 e157
54. K. Bjøro Jr Vascular anomalies of the umbilical cord: I, obstetric implications Early Hum Dev 8 1983 119 127
55. M.L. Hanley, C.V. Ananth, S. Shen-Schwarz, J.C. Smulian, Y.L. Lai, A.M. Vintzileos Placental cord insertion and birth weight discordancy in twin gestations Obstet Gynecol 99 2002 477 482
56. G.A. Machin Some causes of genotypic and phenotypic discordance in monozygotic twin pairs Am J Med Genet 61 1996 216 228
57. M.E. De Paepe, S. Shapiro, L. Young, F.I. Luks Placental characteristics of selective birth weight discordance in diamniotic-monochorionic twin gestations Placenta 31 2010 380 386
58. L. Lewi, M. Cannie, I. Blickstein Placental sharing, birthweight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas Am J Obstet Gynecol 197 2007 587.e1 587.e8
59. M.L. Denbow, P. Cox, M. Taylor, D.M. Hammal, N.M. Fisk Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome Am J Obstet Gynecol 182 2000 417 426
60. L. Lewi, L. Gucciardo, A. Huber Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth Am J Obstet Gynecol 199 2008 511.e1 511.e7
61. H.M. Salihu, M.H. Aliyu, R.S. Kirby In utero nicotine exposure and fetal growth inhibition among twins Am J Perinatol 22 2005 421 427
62. W.D. Schwendemann, J.M. O'Brien, J.R. Barton, D.A. Milligan, N. Istwan Modifiable risk factors for growth restriction in twin pregnancies Am J Obstet Gynecol 192 2005 1440 1442
63. B. Gentilin, S. Guerneri, V. Bianchi Discordant prenatal phenotype and karyotype of monozygotic twins characterized by the unequal distribution of two cell lines investigated by different methods: a review Twin Res Hum Genet 11 2008 352 356
64. W. Sepulveda, N.J. Sebire, K. Hughes, A. Kalogeropoulos, K.H. Nicolaides Evolution of the lambda or twin-chorionic peak sign in dichorionic twin pregnancies Obstet Gynecol 89 1997 439 441
65. S.G. Carroll, P.W. Soothill, S.A. Abdel-Fattah, H. Porter, I. Montague, P.M. Kyle Prediction of chorionicity in twin pregnancies at 10-14 weeks of gestation BJOG 109 2002 182 186
66. N.J. Sebire, C. D'Ercole, W. Soares, R. Nayar, K.H. Nicolaides Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies Obstet Gynecol 91 1998 82 85
67. A. Bhide, S. Sankaran, S. Sairam, A.T. Papageorghiou, B. Thilaganathan Relationship of intertwin crown-rump length discrepancy to chorionicity, fetal demise and birth-weight discordance Ultrasound Obstet Gynecol 34 2009 131 135
68. R.B. Kalish, M. Gupta, S.C. Perni, S. Berman, S.T. Chasen Clinical significance of first trimester crown-rump length disparity in dichorionic twin gestations Am J Obstet Gynecol 191 2004 1437 1440
69. Royal College of Obstetricians Gynaecologists Management of monochorionic twins http://www.rcog.org.uk/files/rcog-corp/uploadedfiles/ T51ManagementMonochorionicTwinPregnancy2008a.pdf Accessed July 1, 2010
70. N.J. Sebire, R.J. Snijders, K. Hughes, W. Sepulveda, K.H. Nicolaides The hidden mortality of monochorionic twin pregnancies BJOG 104 1997 1203 1207
71. O. Barigye, L. Pasquini, P. Galea, H. Chambers, L. Chappell, N.M. Fisk High risk of unexpected late fetal death in monochorionic twins despite intensive ultrasound surveillance: a cohort study PLoS Med 2 2005 e172
72. Y.M. Lee, B.J. Wylie, L.L. Simpson, M.E. D'Alton Twin chorionicity and the risk of stillbirth Obstet Gynecol 111 2008 301 308
73. N.A. Smith, L. Wilkins-Haug, J. Santolaya-Forgas Contemporary management of monochorionic diamniotic twins: outcomes and delivery recommendations revisited Am J Obstet Gynecol 203 2010 133.e1 133.e6
74. A. Shrim, B. Weisz, L. Gindes, R. Gagnon Parameters associated with outcome in third trimester monochorionic diamniotic twin pregnancies J Obstet Gynaecol Can 32 2010 429 434
75. U. Nicolini, A. Poblete Single intrauterine death in monochorionic twin pregnancies Ultrasound Obstet Gynecol 14 1999 297 301
76. J.L. Weiss, J. Cleary-Goldman, K. Tanji, N. Budorick, M.E. D'Alton Multicystic encephalomalacia after first-trimester intrauterine fetal death in monochorionic twins Am J Obstet Gynecol 190 2004 563 565
77. L.D. Devoe, D.J. Ware Antenatal assessment of twin gestation Semin Perinatol 19 1995 413 423
78. M.Y. Divon, Z. Weiner Ultrasound in twin pregnancy Semin Perinatol 19 1995 404 412
79. A. Chittacharoen, P. Leelapattana, R. Rangsiprakarn Prediction of discordant twins by real-time ultrasonography combined with umbilical artery velocimetry Ultrasound Obstet Gynecol 15 2000 118 121
80. C. Lenstrup Predictive value of antepartum non-stress test in multiple pregnancies Acta Obstet Gynecol Scand 63 1984 597 601
81. G.D. Blake, R.A. Knuppel, C.J. Ingardia, M. Lake, G. Aumann, M. Hanson Evaluation of nonstress fetal heart rate testing in multiple gestations Obstet Gynecol 63 1984 528 532
82. J.G. Lodeiro, A.M. Vintzileos, S.J. Feinstein, W.A. Campbell, D.J. Nochimson Fetal biophysical profile in twin gestations Obstet Gynecol 67 1986 824 827
83. D.C. Ding, S. Hsu, T.W. Chu, H.C. Lai, W.H. Chen Utility of Doppler velocimetry in correlating with outcomes in severe discordant twins J Obstet Gynaecol 26 2006 198 199
84. T. Simes, N. Amaral, R. Lerman, F. Ribeiro, E. Dias, I. Blickstein Prospective risk of intrauterine death of monochorionic-diamniotic twins Am J Obstet Gynecol 195 2006 134 139
85. F.A. Chervenak, R.E. Johnson, S. Youcha, J.C. Hobbins, R.L. Berkowitz Intrapartum management of twin gestation Obstet Gynecol 65 1985 119 124
86. V.L. Persad, T.F. Baskett, C.M. O'Connell, H.M. Scott Combined vaginal-cesarean delivery of twin pregnancies Obstet Gynecol 98 2001 1032 1037
87. S.E. Gocke, M.P. Nageotte, T. Garite, C.V. Towers, W. Dorcester Management of the nonvertex second twin: primary cesarean section, external version, or primary breech extraction Am J Obstet Gynecol 161 1989 111 114
88. S.R. Wells, J.M. Thorp Jr, W.A. Bowes Jr Management of the nonvertex second twin Surg Gynecol Obstet 172 1991 383 385
89. S.P. Chauhan, W.E. Roberts, R.A. McLaren, H. Roach, J.C. Morrison, J.N. Martin Jr Delivery of the nonvertex second twin: breech extraction versus external cephalic version Am J Obstet Gynecol 173 1995 1015 1020
90. S.J. Smith, J. Zebrowitz, R.A. Latta Method of delivery of the nonvertex second twin: a community hospital experience J Matern Fetal Med 6 1997 146 150
91. J.G. Mauldin, R.B. Newman, P.D. Mauldin Cost-effective delivery management of the vertex and nonvertex twin gestation Am J Obstet Gynecol 179 1998 864 869
92. C. Robinson, S.P. Chauhan Intrapartum management of twins Clin Obstet Gynecol 47 2004 248 262
93. P. Vergani, A. Locatelli, M. Ratti Preterm twins: what threshold of birth weight discordance heralds major adverse neonatal outcome? Am J Obstet Gynecol 191 2004 1441 1445
94. W. Stein, B. Misselwitz, S. Schmidt Twin-to-twin delivery time interval: influencing factors and effect on short-term outcome of the second twin Acta Obstet Gynecol Scand 87 2008 346 353
95. T.Y. Leung, I.H. Lok, W.H. Tam, T.N. Leung, T.K. Lau Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twin BJOG 111 2004 546 549
96. T. Schmitz, C. Carnavalet Cde, E. Azria, E. Lopez, D. Cabrol, F. Goffinet Neonatal outcomes of twin pregnancy according to the planned mode of delivery Obstet Gynecol 111 2008 695 703
97. N.S. Fox, M. Silverstein, S. Bender, C.K. Klauser, D.H. Saltzman, A. Rebarber Active second stage management in twin pregnancies undergoing planned vaginal delivery in a U.S. population Obstet Gynecol 115 2010 229 233
98. A. Ayres, T.R. Johnson Management of multiple pregnancy: labor and delivery Obstet Gynecol Surv 60 2005 550 554
99. N.W. Hendrix, S.P. Chauhan Sonographic examination of twins: from first trimester to delivery of the second fetus Obstet Gynecol Clin North Am 3 1998 609 621
100. E.V. Kontopoulos, C.V. Ananth, J.C. Smulian, A.M. Vintzileos The influence of mode of delivery on twin neonatal mortality in the US: variance by birth weight discordance Am J Obstet Gynecol 192 2005 252 256
101. C.V. Ananth, K. Demissie, M.L. Hanley Birth weight discordancy and adverse outcome among twin gestations in the United States: the effect of placental abruption Am J Obstet Gynecol 188 2003 954 960
102. M.E. Redman, S.C. Blackwell, J.S. Refuerzo The ninety-fifth percentile for growth discordance predicts complications of twin pregnancy Am J Obstet Gynecol 187 2002 667 671
103. American College of Obstetricians and Gynecologists Antepartum fetal surveillance: ACOG practice bulletin no. 9 1999 The College Washington, DC (reaffirmed 2009)
104. N. Farah, B. Stuart, V. Donnelly, G. Rafferty, M. Turner What is the value of ultrasound soft tissue measurements in the prediction of abnormal fetal growth? J Obstet Gynaecol 29 2009 457 463
105. S.P. Chauhan, D.J. West, J.A. Scardo, J.M. Boyd, J. Joiner, N.W. Hendrix Antepartum detection of macrosomic fetus: clinical versus sonographic, including soft-tissue measurements Obstet Gynecol 95 2000 639 642
106. G. Cevenini, F.M. Severi, C. Bocchi, F. Petraglia, P. Barbini An informative probability model enhancing real time echobiometry to improve fetal weight estimation accuracy Med Biol Eng Comput 46 2008 109 120
107. C.H. Chang, P.Y. Tsai, C.H. Yu, H.C. Ko, F.M. Chang Predicting fetal growth restriction with renal volume using 3-D ultrasound: efficacy evaluation Ultrasound Med Biol 34 2008 533 537
108. C.H. Chang, P.Y. Tsai, C.H. Yu, H.C. Ko, F.M. Chang Prenatal detection of fetal growth restriction by fetal femur volume: efficacy assessment using three-dimensional ultrasound Ultrasound Med Biol 33 2007 335 341