PREDICTION OF 2ND-TRIMESTER INTRAUTERINE GROWTH-RETARDATION AND FETALDEATH IN A DISCORDANT TWIN BY FIRST-TRIMESTER MEASUREMENTS - CASE-REPORT AND REVIEW OF THE LITERATURE

Ultrasound examination at 9 weeks of gestation in a 34-year-old primig ravida showed a twin pregnancy, with discrepancy in the sizes of the t wo gestational sacs, whereas the crown-rump lengths and fetal heart ra tes were virtually identical - the result being an abnormal sac size/c rown-rump length ratio (early oligohydramnios). By 14 weeks discordant heart rates and umbilical artery flow velocities were detected, the d iscordance between the twins increasing as pregnancy progressed. Bipar ietal diameters, femoral lengths, and abdominal circumferences were al so progressively discordant, and at 28 weeks the smaller twin had no h eart beat. At 30 weeks the patient was delivered of a live 1,350-gram infant and a 400-gram dead fetus. This case suggests, in contradistinc tion to several previous reports, that fetal discordance in twin pregn ancies (and perhaps intrauterine growth retardation in general) may be present as early as the first trimester.