Unequal placental sharing and birth weight discordance in monochorionic diamniotic twins.
OBJECTIVE
The purpose of this study was to define the association between unequal placental sharing and birth weight discordance in monochorionic/diamniotic twin pregnancies.


METHODS
The study comprised a prospective cohort of monochorionic/diamniotic twin pregnancies who were delivered in Kaiser Permanente-Northern California, 1997-2003. Dye injection studies of fresh postpartum placentas were performed. Placental sharing, cord insertion combinations, vascular anastomoses, gestational age, and birth weights were recorded. Statistical comparisons of birth weight and gestational age were made with the Student t test. Rates of birth weight discordance were compared with the chi-square test. Multivariate logistic regression models analyzed the relationship between variables of interest.


RESULTS
Mean birth weights for larger and smaller twins were 2400 g and 2109 g, respectively. Twenty-two percent of the monochorionic/diamniotic twin pairs had birth weight discordance > or = 20%, and 8% of these pairs had twin-twin transfusion syndrome. Monochorionic/diamniotic twin pairs with unequal placental sharing had a 9.8 times greater likelihood of birth weight discordance (95% CI, 5.4-17.9) as compared with those pairs with equal placental sharing.


CONCLUSIONS
Unequal placental sharing is a significant risk factor for birth weight discordance in monochorionic/diamniotic twins. Antenatal diagnosis of unequal placental sharing would enable improved counseling in the setting of monochorionic/diamniotic twins.
Fick
Andrea L
AL
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
Feldstein
Vickie A
VA
Norton
Mary E
ME
Wassel Fyr
Christina
C
Caughey
Aaron B
AB
Machin
Geoffrey A
GA
D000650:Amnion; D001724:Birth Weight; D002823:Chorion / Q000002:abnormalities*; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D009929:Organ Size; D010920:Placenta / Q000502:physiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D014427:Twins / Q000502:physiology*; D014469:Umbilical Arteries / Q000002:abnormalities; D014471:Umbilical Veins / Q000002:abnormalities