Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins

2021 ◽  
Vol 48 (4) ◽  
pp. 279-287
Author(s):  
Eran Ashwal ◽  
Liran Hiersch ◽  
Howard Berger ◽  
Amir Aviram ◽  
Arthur Zaltz ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Adjusted Relative Risk ◽  
Placental Pathology ◽  
Specific Measure ◽  
Optimal Cutoff ◽  
Definition Of ◽  
Twin Pregnancies ◽  
Pathologic Basis

<b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> 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). <b><i>Results:</i></b> 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 &#x3c;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. <b><i>Conclusion:</i></b> 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.

The Association between Placental Histopathology, Fetal Growth Restriction, and Preeclampsia in Twin Pregnancies

2019 ◽  
Author(s):  
Kathy C. Matthews ◽  
Nathan S. Fox ◽  
Andrei Rebarber
Keyword(s):  
Fetal Growth ◽  
Growth Curve ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Primary Study ◽  
Composite Outcome ◽  
Placental Pathology ◽  
Significant Difference ◽  
Twin Growth ◽  
Twin Pregnancies

Abstract Objective This study aims to estimate the association between abnormal placental histopathology, fetal growth restriction (FGR), and preeclampsia (PEC) in twin pregnancies. Study Design Retrospective cohort study of women with diamniotic twin pregnancies with live births at ≥24 weeks of gestation and available placental pathology. Findings were compared between women with and without FGR, which was defined as a birthweight <10th percentile, using singleton and twin growth curves, and those with and without PEC. The primary study outcome was a composite of abnormal placental histopathology. Chi-square, Fisher's exact, and Student's t-tests were used for analysis. Results Among 859 patients with diamniotic twins, 806 (93.8%) had placental pathology. A total of 422 (52.4%) women had at least one twin with FGR, using a singleton growth curve. FGR affected 136 (16.9%) pregnancies when a twin growth curve was applied. There was no significant difference in composite outcome between groups, using either growth curve (45.5 vs. 44.8%, p = 0.84; adjusted odds ratio (aOR): 1.06, 95% CI: 0.79–1.40 and 52.2 vs. 43.7%, p = 0.07; aOR: 1.44, 95% CI: 0.90–2.10). A total of 122 of 789 (15.5%) patients developed PEC. There was no significant difference in composite outcome between patients with and without PEC (41.8 vs. 45.4%, p = 0.46; aOR: 0.79, 95% CI: 0.53–1.18). Conclusion In twin pregnancies, FGR and PEC are not associated with abnormal placental histopathology. This suggests that the pathologic placental manifestations of these conditions may differ in twins and include factors other than those commonly described in singletons.

The role of ultrasound in the prediction of birth weight discordance in twin pregnancies: are we there yet?

2018 ◽  
Vol 46 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Ana Raquel Neves ◽  
Filipa Nunes ◽  
Miguel Branco ◽  
Maria do Céu Almeida ◽  
Isabel Santos Silva
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Predictive Value ◽  
Fetal Growth Restriction ◽  
Predictive Performance ◽  
Growth Restriction ◽  
Operating Characteristics ◽  
Tertiary Center ◽  
Fetal Malformations ◽  
Twin Pregnancies

AbstractObjective:To analyze the accuracy of ultrasound prediction of birth weight discordance (BWD) and the influence of chorionicity and fetal growth restriction (FGR) on ultrasound performance.Methods:Retrospective analysis of 176 twin pregnancies at a Portuguese tertiary center, between 2008 and 2014. Last ultrasound biometry was recorded. Cases with delivery before 24 weeks, fetal malformations, interval between last ultrasound and deliver >3 weeks, twin-to-twin transfusion syndrome and monoamniotic pregnancies were excluded. The accuracy of prediction of BWD was assessed using the area under the receiver-operating characteristics curve (AUC).Results:BWD ≥20% was present in 21.6% of twin pregnancies. EBW had the best predictive performance for BWD (AUC 0.838, 95%CI 0.760–0.916), with a negative predictive value of 86.9% and a positive predictive value of 51.3%. Chorionicity did not influence ultrasound performance. None of the biometric variables analyzed was predictive of BWD in pregnancies without FGR.Conclusion:The accuracy of ultrasound in the prediction of BWD is limited, particularly in pregnancies without fetal growth restriction. Clinical decisions should not rely on BWD alone.

scholarly journals Consensus Definition of Fetal Growth Restriction in Intrauterine Fetal Death: A Delphi Procedure

2020 ◽  
Author(s):  
Irene Maria Beune ◽  
Stefanie Elisabeth Damhuis ◽  
Wessel Ganzevoort ◽  
John Ciaran Hutchinson ◽  
Teck Yee Khong ◽  
...  
Keyword(s):  
Birth Weight ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Fetal Death ◽  
Weight Ratio ◽  
Liver Weight ◽  
Growth Restriction ◽  
Intrauterine Fetal Death ◽  
Consensus Definition ◽  
Definition Of

Context.— Fetal growth restriction is a risk factor for intrauterine fetal death. Currently, definitions of fetal growth restriction in stillborn are heterogeneous. Objectives.— To develop a consensus definition for fetal growth restriction retrospectively diagnosed at fetal autopsy in intrauterine fetal death. Design.— A modified online Delphi survey in an international panel of experts in perinatal pathology, with feedback at group level and exclusion of nonresponders. The survey scoped all possible variables with an open question. Variables suggested by 2 or more experts were scored on a 5-point Likert scale. In subsequent rounds, inclusion of variables and thresholds were determined with a 70% level of agreement. In the final rounds, participants selected the consensus algorithm. Results.— Fifty-two experts participated in the first round; 88% (46 of 52) completed all rounds. The consensus definition included antenatal clinical diagnosis of fetal growth restriction OR a birth weight lower than third percentile OR at least 5 of 10 contributory variables (risk factors in the clinical antenatal history: birth weight lower than 10th percentile, body weight at time of autopsy lower than 10th percentile, brain weight lower than 10th percentile, foot length lower than 10th percentile, liver weight lower than 10th percentile, placental weight lower than 10th percentile, brain weight to liver weight ratio higher than 4, placental weight to birth weight ratio higher than 90th percentile, histologic or gross features of placental insufficiency/malperfusion). There was no consensus on some aspects, including how to correct for interval between fetal death and delivery. Conclusions.— A consensus-based definition of fetal growth restriction in fetal death was determined with utility to improve management and outcomes of subsequent pregnancies.

501: Differences in neonatal outcome and placental pathology in relation to the severity of fetal growth restriction

2018 ◽  
Vol 218 (1) ◽  
pp. S300
Author(s):  
Ohad Gluck ◽  
Yossi Mizrachi ◽  
Adi Marciano ◽  
Letizia Schreiber ◽  
Jakob Bar ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Neonatal Outcome ◽  
Growth Restriction ◽  
Placental Pathology

Whole genome miRNA profiling revealed miR-199a as potential placental pathogenesis of selective fetal growth restriction in monochorionic twin pregnancies

Placenta ◽  
2020 ◽  
Vol 92 ◽  
pp. 44-53 ◽  
Author(s):  
Meng Meng ◽  
Yvonne Kwun Yue Cheng ◽  
Ling Wu ◽  
Piya Chaemsaithong ◽  
Maran Bo Wah Leung ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Whole Genome ◽  
Monochorionic Twin ◽  
Mirna Profiling ◽  
Twin Pregnancies

scholarly journals Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

2020 ◽  
Vol 9 (10) ◽  
pp. 3276
Author(s):  
Veronica Giorgione ◽  
Amar Bhide ◽  
Rohan Bhate ◽  
Keith Reed ◽  
Asma Khalil
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Maternal Blood ◽  
Growth Restriction ◽  
Growth Disorders ◽  
Maternal Risk Factors ◽  
Maternal Risk ◽  
Logistic Regression Models ◽  
Twin Pregnancies ◽  
Maternal Blood Pressure

Studies have reported controversial findings on the association between fetal growth restriction (FGR) or intertwin weight discordance and the risk of hypertensive disorders of pregnancy (HDP) in twin pregnancies. The aim of this study was to investigate the association between twin growth disorders and HDP. Twin pregnancies resulting in two live births at St George’s Hospital between 2000 and 2019 were included. FGR or small-for-gestational-age (SGA) at birth was assessed using singleton and twin reference charts. Intertwin discordance [(large birthweight − small birthweight)/(large birthweight) × 100%)] was calculated. Logistic regression models were performed. SGA (aOR 2.34, 95% CI 1.60–3.44, p < 0.001), intertwin discordance ≥25% (aOR 2.10, 95% CI 1.26–3.49, p = 0.004) and their co-existence (aOR 2.03, 95% CI 1.16–3.54, p = 0.013) were significantly associated with HDP. After adjusting for the known maternal risk factors of HDP and the intertwin discordance, SGA (using the twin charts) was the strongest independent risk factor associated with HDP (aOR 2.12, 95% CI 1.40–3.22, p < 0.001) and preeclampsia (aOR 2.34, 95% CI 1.45–3.76, p < 0.001). This study highlights that the presence of at least one SGA twin is significantly associated with HDP during pregnancy. Therefore, maternal blood pressure should be closely monitored in twin pregnancies complicated by SGA with or without intertwin discordance.

scholarly journals Temporal variation in definition of fetal growth restriction in the literature

2019 ◽  
Vol 53 (5) ◽  
pp. 569-570 ◽  
Author(s):  
I. M. Beune ◽  
A. Pels ◽  
S. J. Gordijn ◽  
W. Ganzevoort
Keyword(s):  
Temporal Variation ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Definition Of
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