IS SIZE DISCORDANCY AN INDICATION FOR DELIVERY OF PRETERM TWINS

OBJECTIVE: Our goal was to determine the clinical significance of size discordancy in preterm twins, STUDY DESIGN: A retrospective study was performed to review outcomes of twins delivered between Jan, 1, 1988, and June 30, 1995, Maternal and neonatal records were assessed for de mographic data, maternal medical history, and neonatal mortality and m orbidity outcomes. Discordancy was defined as greater than or equal to 20% difference in birth weight. The chi(2) analysis was performed. RE SULTS: There were 42 sets of discordant twins and 77 sets of concordan t twins in the final analysis. The distribution of gestational ages in both groups was similar. We found no difference in maternal morbidity between the groups. Discordant sets had a significantly longer hospit al stay (p = 0.003) and more cases of hyperbilirubinemia (p = 0.01), b ut there were no other differences in morbid outcomes, There were no d ifferences in outcome variables between the two twins within discordan t sets with respect to gender, size, birth order, growth restriction, or route of delivery. There were no stillbirths among any of the 238 i nfants. Of the 15 neonatal deaths, none occurred in infants delivered after 32 weeks' gestation or in infants weighing >2000 gm at birth. in fants who were small for gestational age had a higher incidence of sep sis (p = 0.043) and longer hospital stays (p = 0.005) compared with in fants who were appropriate for gestational age. CONCLUSIONS: Size disc ordancy alone does not appear to be an indication for preterm delivery of twins. When results of antenatal testing are normal and growth res triction is absent, attempts should be made to achieve a gestational a ge >32 weeks and weight >2000 gm before delivery is considered.