Prevalence of Discordant Growth in Twin Pregnancies - A Cross Sectional Study

Abstract

Background and objective A twin gestation is generally a high risk pregnancy and discordant fetal growth results in adverse perinatal outcomes. This study was undertaken to determine the prevalence of discordant growth in twin pregnancies and the perinatal outcome in twin pregnancies with discordant growth. Methodology This one year cross sectional study was done in the Department of Obstetrics and Gynecology, KLE’S Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2013 to December 2013. A total 93 women with twin pregnancy were studied. Birth weight difference with >15% between twins was regarded as discordant growth. Results The prevalence of discordant growth in twins was 38.71%. Among the babies with discordant growth maximum babies were found to have discordancy between 15.1 to 25 percent 55.5%. Maximum numbers of (36.11%) discordant babies had birth weight between 2000-2499 grams and had apgar score of seven or more at one minute (55.56%) while at five minutes, 1% of the discordant newborns had apgar score of < 7. 41.67% of the discordant newborns required KMC while 44.44% of the discordant newborns had NICU admission and preterm delivery was the commonest cause of NICU admission in discordant babies (76.92%) followed by RDS (17.02% and 15.39%).Perinatal Mortality was noted in 22.22% of the discordant newborns (p=0.03) compared to concordant group which was and significant all of which occured with birth weight discordancy of > 25% . No statistically significant association was noted between maternal age, parity status, gestational age and mode of delivery with growth discordancy (p>0.050) and also no statistically significant association was noted between apgar score at one minute and five minutes, KMC and NICU admission and discordancy (p>0.050). Conclusion Considering the birth weight difference of more than 15% there is higher prevalence of discordancy. The present study showed prevalence of discordancy was as high as 38.71% considering the birth weight difference of more than 15%. Prevalence of Grade –I (15.1 to 25%) discordancy was found in 55.56% and Grade-II (>25%) discordancy was found in 44.44%.There was an increased incidence of perinatal mortality in discordant twins compared to concordant twins which was statistically significant. Perinatal mortality occurred only in discordant twins with Grade-II discordancy. There was no statistical significance in other neonatal outcomes including birth weight, apgar score, admission to NICU,KMC and mode of delivery between concordant and discordant groups. Presence of discordancy in twins is a risk factor for increased perinatal mortality.