ABSTRACT
The objective of this study was to compare the perinatal outcomes in growth-restricted
(IUGR) twins with a matched group of IUGR singletons. We performed a retrospective
cohort study evaluating the perinatal outcomes in IUGR twins matched for gestational
age at delivery to the next four IUGR singletons (1:4) in our perinatal database.
The perinatal outcomes evaluated included rates of uncorrected perinatal mortality
(PMR), admission to the neonatal intensive care unit (NICU), respiratory distress
syndrome, grades 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, periventricular
leukomalacia, and length of NICU stay. A cohort of twins with IUGR were matched with
a cohort of IUGR singletons and compared for perinatal outcomes. A p value < 0.05 was considered significant. During the study period, we identified 99
IUGR twins meeting our inclusion criteria. These were matched with 396 singletons
with IUGR. The mean gestational age at delivery for the twins was 34 ± 3.8 weeks and
35 ± 3.5 weeks for the singletons (p = 0.11). The PMR in twins was significantly higher than in singletons (OR, 2.2; 95%
confidence interval, 1.1 to 5.7). Perinatal morbidity was similarly significantly
higher in IUGR twins. Compared with age-matched singletons, twins with IUGR have higher
perinatal mortality and morbidity rates.
KEYWORDS
Intrauterine growth restriction - twins - singletons - perinatal outcomes
REFERENCES
- 1
Martin J A, Hamilton B E, Sutton P D, Vetura S J, Menacker F, Munson M L.
Births: final data for 2002.
Nat Vital Stat.
2003;
52
1-113
- 2
Amaru R C, Bush M C, Berkowitz R L, Lapinski R H, Gaddipati S.
Is discordant growth in twins an independent risk factor for adverse neonatal outcome?.
Obstet Gynecol.
2004;
103
71-76
- 3
Spellacy W N, Handler A, Ferre C D.
A case-control study of 1253 twin pregnancies from a 1982-1987 perinatal database.
Obstet Gynecol.
1990;
75
168-171
- 4
Koops B I, Morgan L J, Battaglia F C.
Neonatal mortality risk in relation to birth weight and gestational age: update.
J Pediatr.
1982;
101
969-977
- 5
Spinillo A, Capuzzo E, Egbe T O, Fazzi E, Calonna L, Nicola S.
Pregnancies complicated by idiopathic intrauterine growth retardation: severity of
growth failure, neonatal morbidity and two-year neurodevelopmental outcome.
J Reprod Med.
1995;
10
209-215
- 6
Bleker O P, Breur W, Huidekoper B L.
A study of birth weight, placental weight, and mortality of twins as compared to singletons.
Br J Obstet Gynaecol.
1979;
86
111-118
- 7
McCarthy B J, Sachs B P, Layde P M, Burton A, Terry J S, Rochat R.
The epidemiology of neonatal death in twins.
Am J Obstet Gynecol.
1981;
141
252-256
- 8
Williams R L, Creasy R K, Cunningham G C, Hawes W E, Norris F D, Tashiro M.
Fetal growth and perinatal viability in California.
Obstet Gynecol.
1982;
59
624-632
- 9
Buekins P, Wilcox A.
Why do small twins have a lower mortality rate than small singletons.
Am J Obstet Gynecol.
1993;
168
937-941
- 10
Kilpatrick S J, Jackson R, Croughan-Minihane M S.
Perinatal mortality in twins and singletons matched for gestational age at delivery
at greater or equal to 30 weeks.
Am J Obstet Gynecol.
1996;
174
66-71
- 11
Baker E R, Beach M L, Craigo S D, Harvey-Wilkes K B, D'Alton M E.
A comparison of neonatal outcomes of age-matched, growth-restricted twins and growth-restricted
singletons.
Am J Perinatol.
1997;
14
499-502
- 12
Brenner W E, Edelman D A, Hendricks C H.
A standard of fetal growth for the United States of America.
Am J Obstet Gynecol.
1976;
126
555-564
- 13
Ananth C V, Vintzileos A M, Shen-Schwarz S, Smulian J C, Lai Y.
Standards of birth weight in twin gestations stratified by placental chorionicity.
Obstet Gynecol.
1998;
91
917-924
- 14
Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M.
A United States national reference for fetal growth.
Obstet Gynecol.
1996;
87
163-168
A. O OdiboM.D.
2000 Ravdin Courtyard
3400 Spruce Street, Philadelphia, PA 19104