Early neonatal morbidity and mortality in growth-discordant twins.
OBJECTIVE
To evaluate early neonatal morbidity and mortality in twin pregnancies with growth discordance.


METHODS
Retrospective study.


METHODS
Tertiary teaching hospital, Sao Paulo, Brazil.


METHODS
A total of 151 twin pregnancies managed and delivered at the Multiple Pregnancy Unit at Sao Paulo University Hospital between 1998 and 2004. METHODS; Comparison between twin pregnancies with weight discordance > or =20% and pregnancies concordant for fetal weight. Cases with fetal death, abnormalities, twin-to-twin transfusion and delivery before 26 weeks or in another hospital were excluded.


METHODS
Early neonatal morbidity (Apgar at 5 minutes <7, respiratory or neurological complications, infection, necrotizing enterocolitis, length of hospital stay) and mortality.


RESULTS
Forty (26.5%) pregnancies presented discordance > or =20% and 111 (73.5%) were concordant. In the discordant group, 75% of pregnancies had at least one growth restricted fetus (<10th centile). In concordant twin pregnancies, monochorionic cases (22.5%) presented with lower gestational age (34.3 vs. 36.2 weeks), lower birthweight (2,067 vs. 2,334 g) and a longer period of hospital stay (5.5 vs. 3.0) compared to dichorionic concordant twins. No differences between monochorionic and dichorionic subgroups were observed in discordant twins. Pregnancies in which at least one baby was born with a birthweight below the 10th centile showed that discordant pregnancies had a lower gestational age at delivery (35.2 vs. 36.8 weeks) and a longer period of hospital stay (9 vs. 4 weeks) compared to concordant cases. Neonatal mortality was similar in discordant (3.7%) and concordant (4.5%) twins.


CONCLUSIONS
Early perinatal morbidity is increased in twin pregnancies with birthweight discordance > or =20% only when associated with fetal growth restriction and low birthweight.
Alam Machado
Rita De Cássia
Rde C
Department of Obstetrics, Hospital das Clínicas, São Paulo University Medical School, Brazil. rita.alam@ig.com.br
Brizot
Maria De Lourdes
Mde L
Liao
Adolfo Wenjaw
AW
Krebs
Vera Lucia Jornada
VL
Zugaib
Marcelo
M
D001724:Birth Weight; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D011247:Pregnancy; D014427:Twins