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Published on: June 29, 2013
Association between intrauterine growth restriction and patent ductus arteriosus: Use of a dichorionic twin pregnancy
Chung-Yuan Yang1, Michael Fw Hoong2, Chung-Sing Li3
1Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Insights
Intrauterine growth restriction (IUGR) in dichorionic twins significantly increases the risk of developing patent ductus arteriosus (PDA) and hemodynamically significant PDA (Hs-PDA). This finding highlights the importance of monitoring growth-restricted fetuses for cardiac complications.
Area of Science:
- Neonatal Medicine
- Perinatology
- Fetal Cardiology
Background:
- Selective intrauterine growth restriction (sIUGR) in dichorionic (DC) twins presents unique challenges in fetal development.
- Patent ductus arteriosus (PDA) is a common neonatal complication, and its hemodynamically significant form (Hs-PDA) can lead to severe morbidity.
Purpose of the Study:
- To investigate the association between sIUGR in dichorionic twins and the incidence of PDA and Hs-PDA.
- To identify risk factors and outcomes related to PDA in this specific twin population.
Main Methods:
- Observational cohort study and retrospective case assessment of DC twins born between 2013-2018.
- sIUGR defined by >25% birth weight discordance and smaller twin <10th percentile.
- PDA and Hs-PDA diagnosed via echocardiography postnatally.
Main Results:
- Among 53 DC twins with sIUGR, PDA occurred in 28.30% and Hs-PDA in 24.53%, significantly higher than in appropriate for gestational age co-twins (7.55% and 5.66%, respectively).
- Twins with PDA experienced higher rates of preterm birth and lower gestational age at delivery.
- Small gestational age at delivery was a significant predictor for both PDA and Hs-PDA.
Conclusions:
- Selective IUGR in dichorionic twins is associated with an increased risk of developing PDA and Hs-PDA.
- Early identification and monitoring of sIUGR fetuses are crucial for managing potential cardiac complications.
Objective:
To evaluate the association between intrauterine growth restriction (IUGR) and the incidence of fetuses with patent ductus arteriosus (PDA) and Hemodynamically significant PDA (Hs-PDA) in dichorionic twins (DC) with selective IUGR.
Materials And Methods:
This is an observational cohort study and retrospective case assessment, involved twins born at Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan between 2013 and 2018. DC twins with selective IUGR (sIUGR) were defined as the presence of a birth weight discordance of >25% and a smaller twin with a birth weight below the tenth percentile. PDA was diagnosed using echocardiography between postnatal day 3 and 7. Hs-PDA was defined as PDA plus increased pulmonary circulation, poor systemic perfusion, cardiomegaly, pulmonary edema, or hypotension requiring pharmacotherapeutic intervention.
Result:
A total of 1187 twins were delivered during the study period, and 53 DC twins with selective IUGR were included in this study. DC twins with PDA have higher rate of preterm birth, lower gestational age of delivery, and lower mean birth weight of both twins compared with DC twins without PDA. In a comparison of the sIUGR twin with the appropriate for gestational age co-twin, both the incidences of PDA (28.30% vs. 7.55%, respectively; P = 0.003) and Hs-PDA (24.53% vs. 5.66%, respectively; P = 0.002) were higher in sIUGR fetuses than in the appropriate for gestational age co-twins. Small gestational age of delivery was the only variable to predict PDA and Hs-PDA [p = 0.002, Odds ratio = 0.57 (0.39-0.82), p = 0.009, Odds ratio = 0.71 (0.55-0.92), respectively].
Conclusion:
An analysis of dichorionic twins with sIUGR indicated that IUGR increased the risk of PDA and hemodynamically significant PDA.
