The effect of placental location identified before delivery on birthweight discordance among diamniotic-dichorionic twin pregnancies: a three-year retrospective cohort study

Is there an impact of fetal sex in dichorionic discordant twins on placental histopathological abnormalities?

INTRODUCTION

Growth discordancy in dichorionic diamniotic (DCDA) twin gestations is a known complication associated with adverse neonatal outcomes. We aimed to study the differences in placental pathology, in relation to fetal sex, in DCDA twin gestations complicated with growth discordancy.

METHODS

The medical files of all DCDA twin deliveries complicated by growth discordancy between 2010 and 2020 were reviewed. Growth discordance was defined as a gap between twin birthweights > 20%. A comparison was made between female vs. male growth discordant twins. Placental lesions were classified as lesions related to maternal or fetal malperfusion lesions (MVM, FVM), vascular and villous changes, and inflammatory lesions.

RESULTS

Included 174 DCDA twins. Eighty-eight were in the discordant female group and eighty-six in the discordant male group. The groups did not differ in maternal demographics, pregnancy characteristics, and neonatal outcome. The discordant male group had a higher rate of placental MVM lesions as compared to the discordant female group (p = 0.003). The increased rate of placental MVM lesions in the discordant male group compared to the discordant female group did not change whether its co-twin was of similar or opposite sex.

DISCUSSION

Higher rate of MVM lesions characterizes growth discordant male neonates in DCDA twin gestations. This finding could represent a different adaptation of male fetuses to a hostile intrauterine environment.

Establishment of reference intervals of complete blood count for twin pregnancy

BACKGROUND

Twin pregnancy poses a high risk, and its incidence has increased in recent years. Establishment of reference intervals of complete blood count (CBC) for women with twin pregnancies during pregnancy may aid in the prognosis of adverse outcomes.

METHODS

The incidence of complications and the intensity associated with adverse outcomes were analyzed in 1153 cases of twin pregnancy. A total of 253 cases in the twin pregnancy reference cohort were screened from all candidates after complications and adverse pregnancy outcomes were excluded. Complete blood count data were collected during the mid- and late-term of pregnancy and analyzed using SPSS to establish the reference intervals for peripheral blood in twin pregnancy.

RESULTS

Premature rupture of the membrane and pelvic inflammatory disease were highly positively correlated with adverse outcomes, with OR values of 3.31 and 3.81, respectively. Within the interval population with normal outcomes, red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), and platelet (PLT) values were lower in twin-pregnant women during gestation than in healthy nulligravida women, but the levels of white blood cells (WBC), neutrophils (NEU), and the NEU% increased, especially in the mid-term. The reference intervals of late-term pregnancy were validated using 20 twin pregnancies samples, and then utilized to determine the distinctive CBC characteristics in preterm birth (PTB) pregnancy. Absolute WBC and NEU values increased in PTB pregnancy based on our established reference intervals, which suggests that these may might be prognostic indicators of this adverse outcome.

CONCLUSION

Establishing the reference interval of blood cell-related indicators of normal twin pregnancy is helpful for the monitoring and prognosis of gestation.