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How small is too small in a twin pregnancy?
E F Hamilton1, R W Platt, L Morin
1Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, Quebec, Canada.
American Journal of Obstetrics and Gynecology
|October 3, 1998
Summary
Small twins with growth restriction do not have a survival advantage. Monochorionic twins, specifically, face a significantly higher risk of perinatal death compared to singletons.
Area of Science:
- Perinatal Medicine
- Maternal-Fetal Medicine
- Neonatology
Background:
- Growth restriction in twins is a significant concern for perinatal outcomes.
- Understanding survival differences between twin types and singletons is crucial for clinical management.
Purpose of the Study:
- To investigate if small twins (monochorionic and dichorionic) have a survival advantage over small singletons.
- To identify specific risks associated with twin growth restriction after controlling for confounding factors.
Main Methods:
- A hospital-based cohort study analyzed births between 1980-1995 (24-43 weeks gestation).
- Logistic regression was employed to estimate perinatal mortality risks for monochorionic and dichorionic twins with growth restriction.
- Adjustments were made for gestational age, maternal age, parity, delivery method, and congenital malformations.
Main Results:
- The study included 1062 dichorionic twins, 354 monochorionic twins, and 59,873 singletons.
- Small monochorionic twins (<10th percentile birth weight) showed a 2.45-fold increased risk of perinatal death compared to singletons.
- Small dichorionic twins did not exhibit an increased risk of perinatal mortality (OR 0.91).
Conclusions:
- Twins with growth restriction do not possess a survival advantage and are not protected against perinatal loss.
- Monochorionic twins with growth restriction face a substantially higher risk of perinatal mortality than their singleton counterparts.
- Dichorionic twins with growth restriction do not appear to have an elevated risk of perinatal death.