title: Perinatal complications of monochorionic diamniotic twin gestations with discordant crown-rump length determined at mid-first trimester.
abstract: OBJECTIVE
  The aim of this study was to investigate the value of discordance of crown-rump length (DCRL) at mid-first trimester to predict adverse outcomes in monochorionic diamniotic twin gestations (MD).
  
  
  METHODS
  This was a retrospective cohort study of the perinatal outcome in MD pregnancies managed from the first trimester onward. DCRL was evaluated between 8 and 10 weeks of gestation. The association between DCRL and perinatal complications, including fetal death, twin-twin transfusion syndrome, severe discordant birthweight (DB), and twin anemia-polycythemia sequence, was assessed.
  
  
  RESULTS
  Among 126 cases, a single fetal demise occurred in two (2%) and demise of both fetuses occurred in eight (6%). Five pregnancies (4%) were complicated with twin-twin transfusion syndrome; one case (1%) was twin anemia-polycythemia sequence and 13 (10%) were DB. Neonatal death occurred in one pair. At 28 days of age, in 115 cases (91%) both twins were alive. In 117 cases (93%), at least one twin survived until 28 days of age. DCRL >12.0% was not related to any perinatal complications but DB (P < 0.01; relative risk: 1.40; 95% confidence interval: 1.06-1.84).
  
  
  CONCLUSIONS
  DCRL in MD during the mid-first trimester might be useful for predicting DB.
authors.affiliation: Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan; Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Nakayama
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Haruna
authors.initials: H
authors.lastname: Kawaguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Murata
authors.forename: Shusaku
authors.initials: S
authors.lastname: Hayashi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Mitsuda
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D018568:Crown-Rump Length; D005321:Extraembryonic Membranes; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D066087:Perinatal Death; D011086:Polycythemia / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: discordant crown-rump length; monochorionic twin; perinatal outcome; twin anemia-polycythemia sequence; twin-twin transfusion syndrome