Is Size Discordancy an Indication for Delivery of Preterm Twins?

<p> <p id="x-x-simple-para.0025"> <strong> Objective: </strong> Our goal was to determine the clinical significance of size discordancy in preterm twins. <p id="x-x-simple-para.0030"> <strong> Study Design: </strong> A <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/retrospective-study" title="Learn more about Retrospective Study"> retrospective study </a> was performed to review outcomes of twins delivered between Jan. 1, 1988, and June 30, 1995. Maternal and neonatal records were assessed for demographic data, maternal <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/medical-history" title="Learn more about Medical History"> medical history </a> , and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/newborn-morbidity" title="Learn more about Newborn Morbidity"> neonatal mortality and morbidity </a> outcomes. Discordancy was defined as &ge;20% difference in <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/birth-weight" title="Learn more about Birth Weight"> birth weight </a> . The &chi; ² analysis was performed. <strong> Results: </strong> There were 42 sets of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/twin-discordance" title="Learn more about Twin Discordance"> discordant twins </a> and 77 sets of concordant twins in the final analysis. The distribution of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/gestational-age" title="Learn more about Gestational Age"> gestational ages </a> in both groups was similar. We found no difference in <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/maternal-morbidity" title="Learn more about Maternal Morbidity"> maternal morbidity </a> between the groups. Discordant sets had a significantly longer hospital stay ( <em> p </em> = 0.003) and more cases of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/hyperbilirubinemia" title="Learn more about Hyperbilirubinemia"> hyperbilirubinemia </a> ( <em> p </em> = 0.01), but there were no other differences in morbid outcomes. There were no differences in outcome variables between the two twins within discordant sets with respect to gender, size, <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/birth-order" title="Learn more about Birth Order"> birth order </a> , growth restriction, or route of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/obstetric-delivery" title="Learn more about Obstetric Delivery"> delivery </a> . There were no <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/stillbirth" title="Learn more about Stillbirth"> stillbirths </a> among any of the 238 infants. Of the 15 <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/newborn-death" title="Learn more about Newborn Death"> neonatal deaths </a> , none occurred in infants delivered after 32 weeks' gestation or in infants weighing &gt;2000 gm at birth. Infants who were <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/small-for-gestational-age" title="Learn more about Small for Gestational Age"> small for gestational age </a> had a higher incidence of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/sepsis" title="Learn more about Sepsis"> sepsis </a> ( <em> p </em> = 0.043) and longer hospital stays ( <em> p </em> = 0.005) compared with infants who were appropriate for gestational age. </p> <p> <strong> Conclusions: </strong> Size discordancy alone does not appear to be an indication for <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/premature-labor" title="Learn more about Premature Labor"> preterm delivery </a> of twins. When results of antenatal testing are normal and growth restriction is absent, attempts should be made to achieve a gestational age &gt;32 weeks and weight &gt;2000 gm before delivery is considered. </p> </p></p>