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Am J Perinatol 2021; 38(07): 649-656
DOI: 10.1055/s-0040-1721697
SMFM Fellowship Series Article

Outcomes of Monochorionic, Diamniotic Twin Pregnancies with Prenatally Diagnosed Intertwin Weight Discordance

Nasim C. Sobhani 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
,
Teresa N. Sparks
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Kristen A. Gosnell
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Larry Rand
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Juan M. Gonzalez
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Vickie A. Feldstein
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
3   Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
› Author Affiliations Funding T.N.S. is supported by grant 5K12HD001262-18 from the National Institutes of Health (NIH). The contents of the publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
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Abstract

Objective Monochorionic, diamniotic (MCDA) twin pairs are predisposed to various pregnancy complications due to the unique placental angioarchitecture of monochorionicity. Few studies have evaluated the outcomes of weight-discordant MCDA pairs without selective fetal growth restriction (SFGR) or the risk factors for development of SFGR. This study aims to describe the natural history of expectant, noninvasive management of weight-discordant MCDA twins and to evaluate risk factors associated with progression to SFGR.

Study Design This was a retrospective cohort study at a single, tertiary care center in the United States. All MCDA twins with isolated intertwin weight discordance (ITWD) ≥ 20% diagnosed before 26 weeks' gestational age (GA) were included. The primary outcome of descriptive analyses was overall pregnancy outcome, incorporating both survival to delivery and GA at delivery, as defined by the North American Fetal Therapy Network. The secondary outcome was SFGR in one twin (defined as estimated fetal weight < 10% for GA) and factors associated with this progression. Only those with fetal ultrasound (US) within 4 weeks of delivery were included in this secondary analysis.

Results Among 73 MCDA pairs with ITWD, 73% had a good pregnancy outcome, with dual live delivery at a median GA of 33 weeks. Among the 34 pairs with adequate US follow-up, 56% developed SFGR. There were no differences in GA at delivery or discordance at birth between those who did and those who did not develop SFGR. There was a nonsignificant association between increasing ITWD at diagnosis and subsequent development of SFGR.

Conclusion Expectant, noninvasive management can be considered in MCDA twin pregnancies with ITWD ≥ 20% diagnosed before 26 weeks. This approach is associated with a good pregnancy outcome in the majority of cases, even after the development of SFGR in the smaller twin.

Key Points

  • Nearly 75% of weight-discordant mo/di twins have a good pregnancy outcome.

  • Weight-discordant mo/di twins deliver at a mean gestational age of 33 weeks without invasive therapy.

  • Noninvasive management should be considered for weight-discordant mo/di twins.

Keywords

monochorionic - unequal placental sharing - growth discordance - discordant MCDA twins

Note

This study was approved by the University of California San Francisco (UCSF) Committee on Human Research (study number 17-23011, approval date September 14, 2017).


Previous Presentation

A portion of these data was presented in poster format at the 39th Annual Meeting of the Society for Maternal-Fetal Medicine (SMFM) in Las Vegas, NV, February 16, 2019.




Publication History

Received: 23 June 2020

Accepted: 04 November 2020

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

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