The definition, diagnosis, and management of growth-discordant twins: an international census survey.
In order to establish a protocol considering the definition, diagnosis, and management of growth-discordant twin gestations, a questionnaire was sent to 96 authors of twin-related obstetric articles. The views of the 61 responders comprise this international census survey. The data suggest that a clear cut-off value for discordancy is still needed; however, the data indirectly supported a two-grade definition, namely, mild (greater than 15% and less than 25% birth-weight disparity) and severe (greater than 25%) growth discordants. Expectant management was advocated by the majority of participants with out-patient follow-up for mild discordants, while severe discordants may preferably be hospitalized. Follow-up should be done by non-stress testing (daily - 2/wk), biophysical profile (1-2/wk), Doppler velocimetry (1/wk - bi-weekly) and sonographic biometry (bi-weekly). The opinions considering termination of pregnancy because of intertwin growth discordancy were divided; however, discordancy per se, was not considered an indication for cesarean delivery. An adapted management flowchart that summarizes the survey's data is presented and may be used as a standard for future investigations.
Blickstein
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Department of Obstetrics and Gynecology, Kaplan Hospital, Rehovot, Israel.
D001724:Birth Weight; D036861:Delivery, Obstetric; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012985:Software Design; D011795:Surveys and Questionnaires; D014427:Twins; D016216:Ultrasonography, Prenatal