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Obstetrics
Diagnosis
Multiple Gestations
Discordant Twin Growth
Discordant Twin Growth
Anne M. Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Literature confusing on topic because of variable definitions of discordant twin growth (DTG), fetal growth restriction (FGR)
                • DTG: Estimated fetal weight (EFW) difference 20% vs. 25%
                  • Or at least 1 twin with FGR
                  • Or 1 twin with FGR + 25% difference birth weight, not EFW
                  • Or FGR + abnormal Doppler
                • FGR: EFW < 10th vs. < 5th vs. < 3rd percentiles
                  • Or AC < 5th percentile
              • Per American College Obstetricians and Gynecologists practice bulletin, DTG is most commonly defined as 20% difference in EFW between larger and smaller fetuses
              • Percentage difference in EFW = EFW larger - EFW smaller/EFW larger x 100

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Gross Pathologic & Surgical Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Halling C et al: Neuro-developmental outcome of a large cohort of growth discordant twins. Eur J Pediatr. ePub, 2015
                                  2. Allaf MB et al: Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? J Ultrasound Med. 33(9):1573-8, 2014
                                  3. Cohen A et al: The influence of prolonged preterm premature rupture of the membranes on neonatal outcome of the presenting and non-presenting twin. Eur J Obstet Gynecol Reprod Biol. 181:28-31, 2014
                                  4. D'Antonio F et al: Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG. 121(4):422-9, 2014
                                  5. Inklaar MJ et al: Cerebral injury in monochorionic twins with selective intrauterine growth restriction: a systematic review. Prenat Diagn. 34(3):205-13, 2014
                                  6. Johansen ML et al: Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies? Ultrasound Obstet Gynecol. 43(3):277-83, 2014
                                  7. Lewi L et al: Growth discordance. Best Pract Res Clin Obstet Gynaecol. 28(2):295-303, 2014
                                  8. Nakayama S et al: Perinatal complications of monochorionic diamniotic twin gestations with discordant crown-rump length determined at mid-first trimester. J Obstet Gynaecol Res. 40(2):418-23, 2014
                                  9. Byers BD et al: Twin pregnancies discordant for single umbilical artery. J Reprod Med. 58(5-6):241-5, 2013
                                  10. D'Antonio F et al: Crown-rump length discordance and adverse perinatal outcome in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 41(6):621-6, 2013
                                  11. Harper LM et al: Significance of growth discordance in appropriately grown twins. Am J Obstet Gynecol. 208(5):393.e1-5, 2013
                                  12. Breathnach FM et al: Fetal growth disorders in twin gestations. Semin Perinatol. 36(3):175-81, 2012
                                  13. Kent EM et al: Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT study. Am J Obstet Gynecol. 207(3):220, 2012
                                  14. Breathnach FM et al: Definition of intertwin birth weight discordance. Obstet Gynecol. 118(1):94-103, 2011
                                  15. Alam Machado Rde C et al: Early neonatal morbidity and mortality in growth-discordant twins. Acta Obstet Gynecol Scand. 88(2):167-71, 2009
                                  16. Lewi L et al: Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth. Am J Obstet Gynecol. 199(5):511, 2008
                                  17. Bagchi S et al: Birth weight discordance in multiple gestations: occurrence and outcomes. J Obstet Gynaecol. 26(4):291-6, 2006
                                  18. Kingdom JC et al: Discordant growth in twins. Prenat Diagn. 25(9):759-65, 2005
                                  19. Rustico MA et al: Managing twins discordant for fetal anomaly. Prenat Diagn. 25(9):766-71, 2005
                                  20. Adegbite AL et al: Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight. Am J Obstet Gynecol. 190(1):156-63, 2004
                                  21. Blickstein I et al: Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin. Am J Obstet Gynecol. 190(1):170-4, 2004
                                  22. Blickstein I et al: Birthweight discordance in multiple pregnancy. Twin Res. 6(6):526-31, 2003
                                  23. Branum AM et al: The effect of birth weight discordance on twin neonatal mortality. Obstet Gynecol. 101(3):570-4, 2003
                                  24. Kalish RB et al: First trimester prediction of growth discordance in twin gestations. Am J Obstet Gynecol. 189(3):706-9, 2003
                                  25. Caravello JW et al: Sonographic examination does not predict twin growth discordance accurately. Obstet Gynecol. 89(4):529-33, 1997
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Definitions

                                              • Literature confusing on topic because of variable definitions of discordant twin growth (DTG), fetal growth restriction (FGR)
                                                • DTG: Estimated fetal weight (EFW) difference 20% vs. 25%
                                                  • Or at least 1 twin with FGR
                                                  • Or 1 twin with FGR + 25% difference birth weight, not EFW
                                                  • Or FGR + abnormal Doppler
                                                • FGR: EFW < 10th vs. < 5th vs. < 3rd percentiles
                                                  • Or AC < 5th percentile
                                              • Per American College Obstetricians and Gynecologists practice bulletin, DTG is most commonly defined as 20% difference in EFW between larger and smaller fetuses
                                              • Percentage difference in EFW = EFW larger - EFW smaller/EFW larger x 100

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • Gross Pathologic & Surgical Features

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Halling C et al: Neuro-developmental outcome of a large cohort of growth discordant twins. Eur J Pediatr. ePub, 2015
                                                                  2. Allaf MB et al: Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? J Ultrasound Med. 33(9):1573-8, 2014
                                                                  3. Cohen A et al: The influence of prolonged preterm premature rupture of the membranes on neonatal outcome of the presenting and non-presenting twin. Eur J Obstet Gynecol Reprod Biol. 181:28-31, 2014
                                                                  4. D'Antonio F et al: Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG. 121(4):422-9, 2014
                                                                  5. Inklaar MJ et al: Cerebral injury in monochorionic twins with selective intrauterine growth restriction: a systematic review. Prenat Diagn. 34(3):205-13, 2014
                                                                  6. Johansen ML et al: Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies? Ultrasound Obstet Gynecol. 43(3):277-83, 2014
                                                                  7. Lewi L et al: Growth discordance. Best Pract Res Clin Obstet Gynaecol. 28(2):295-303, 2014
                                                                  8. Nakayama S et al: Perinatal complications of monochorionic diamniotic twin gestations with discordant crown-rump length determined at mid-first trimester. J Obstet Gynaecol Res. 40(2):418-23, 2014
                                                                  9. Byers BD et al: Twin pregnancies discordant for single umbilical artery. J Reprod Med. 58(5-6):241-5, 2013
                                                                  10. D'Antonio F et al: Crown-rump length discordance and adverse perinatal outcome in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 41(6):621-6, 2013
                                                                  11. Harper LM et al: Significance of growth discordance in appropriately grown twins. Am J Obstet Gynecol. 208(5):393.e1-5, 2013
                                                                  12. Breathnach FM et al: Fetal growth disorders in twin gestations. Semin Perinatol. 36(3):175-81, 2012
                                                                  13. Kent EM et al: Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT study. Am J Obstet Gynecol. 207(3):220, 2012
                                                                  14. Breathnach FM et al: Definition of intertwin birth weight discordance. Obstet Gynecol. 118(1):94-103, 2011
                                                                  15. Alam Machado Rde C et al: Early neonatal morbidity and mortality in growth-discordant twins. Acta Obstet Gynecol Scand. 88(2):167-71, 2009
                                                                  16. Lewi L et al: Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth. Am J Obstet Gynecol. 199(5):511, 2008
                                                                  17. Bagchi S et al: Birth weight discordance in multiple gestations: occurrence and outcomes. J Obstet Gynaecol. 26(4):291-6, 2006
                                                                  18. Kingdom JC et al: Discordant growth in twins. Prenat Diagn. 25(9):759-65, 2005
                                                                  19. Rustico MA et al: Managing twins discordant for fetal anomaly. Prenat Diagn. 25(9):766-71, 2005
                                                                  20. Adegbite AL et al: Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight. Am J Obstet Gynecol. 190(1):156-63, 2004
                                                                  21. Blickstein I et al: Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin. Am J Obstet Gynecol. 190(1):170-4, 2004
                                                                  22. Blickstein I et al: Birthweight discordance in multiple pregnancy. Twin Res. 6(6):526-31, 2003
                                                                  23. Branum AM et al: The effect of birth weight discordance on twin neonatal mortality. Obstet Gynecol. 101(3):570-4, 2003
                                                                  24. Kalish RB et al: First trimester prediction of growth discordance in twin gestations. Am J Obstet Gynecol. 189(3):706-9, 2003
                                                                  25. Caravello JW et al: Sonographic examination does not predict twin growth discordance accurately. Obstet Gynecol. 89(4):529-33, 1997
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