Discordant twins: diagnosis, evaluation and management

Approximately 16% of twin gestations have discordance of at least 20%. We identified 14 risk factors for divergent growth that can be categorized as maternal, fetal, or placental. Determination of chorionicity and serial ultrasound evaluation with a high index of suspicion for divergent growth is re...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2012, Vol.206 (1), p.10-20
Main Authors: Miller, Jena, MD, Chauhan, Suneet P., MD, Abuhamad, Alfred Z., MD
Format: Article
Language:English
Subjects:
Biological and medical sciences
Birth Weight
Chorion - diagnostic imaging
chorionicity
discordance
discordant twins
Diseases in Twins - diagnosis
Diseases in Twins - diagnostic imaging
Diseases in Twins - epidemiology
Female
Fetal Mortality
Growth Disorders - diagnosis
Growth Disorders - diagnostic imaging
Growth Disorders - epidemiology
Gynecology. Andrology. Obstetrics
Humans
Medical sciences
Obstetrics and Gynecology
Pregnancy
Pregnancy Trimester, First
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Risk Factors
Twins - statistics & numerical data
Ultrasonography, Prenatal
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Summary:Approximately 16% of twin gestations have discordance of at least 20%. We identified 14 risk factors for divergent growth that can be categorized as maternal, fetal, or placental. Determination of chorionicity and serial ultrasound evaluation with a high index of suspicion for divergent growth is required for the diagnosis and stratification of risk. The highest reported likelihood ratio for detection of discordance was 5.9 during the first trimester examination and 6.0 for the second trimester. Although our ability to identify discordant twins is limited, once suspected and at viable gestational age, these pregnancies should have antepartum testing. Discordant growth alone is not an indication for preterm birth. Although there are multiple publications on the increased morbidity and mortality rates with discordant growth, there is a paucity of reports on how to manage them optimally and deliver them in a timely manner.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2011.06.075