Meeting paper
SMFM paper
Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT Study

Presented at the 32nd annual meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Feb. 6-11, 2012.
https://doi.org/10.1016/j.ajog.2012.06.022Get rights and content

Objective

We sought to evaluate the association between placental histological abnormalities and birthweight discordance and growth restriction in twin pregnancies.

Study design

We performed a multicenter, prospective study of twin pregnancies. Placentas were examined for evidence of infarction, retroplacental hemorrhage, chorangioma, subchorial fibrin, or abnormal villus maturation. Association of placental lesions with chorionicity, birthweight discordance, and growth restriction were assessed.

Results

In all, 668 twin pairs were studied, 21.1% monochorionic and 78.9% dichorionic. Histological abnormalities were more frequent in placentas of smaller twins of birthweight discordant pairs (P = .02) and in placentas of small for gestational age infants (P = .0001) when compared to controls. The association of placental abnormalities with both birthweight discordance and small for gestational age was significant for dichorionic twins (P = .01 and .0001, respectively). No such association was seen in monochorionic twins.

Conclusion

In a large, prospective, multicenter study, we observed a strong relationship between abnormalities of placental histology and birthweight discordance and growth restriction in dichorionic, but not monochorionic, twin pregnancies.

Section snippets

Materials and Methods

The Evaluation of Sonographic Predictors of Restricted Growth in Twins (ESPRiT) Study was a prospective, multicenter, observational study of twin pregnancies carried out by the Perinatal Ireland Research Consortium at 8 tertiary-level obstetric units in Ireland from May 2007 through October 2009. The ESPRiT Study was set up with the primary aim of establishing a level of birthweight discordance in twin pregnancies that would serve as an independent predictor of adverse perinatal outcome. The

Results

Of 1001 twin pairs recruited to the ESPRiT Study, 66.7% (n = 668) had complete placental pathological examination data available for analyses. Of these, 21.1% (n = 141) were monochorionic and 78.9% (n = 527) dichorionic. Table 1 illustrates the clinical characteristics of the cohort. Monochorionic twins were delivered at an earlier mean gestational age and were on average 302 g lighter than their dichorionic counterparts. The relative frequency of both birthweight discordance of ≥20% and

Comment

It is now well established that twin pregnancies with evidence of growth discordance are at increased risk for perinatal mortality and morbidity.5 Placental histological examination is vital in the evaluation of intrauterine growth restriction. Studies in singletons have shown morphological changes in villus structure in placentas of fetuses affected by intrauterine growth restriction.8, 10, 11 The abnormalities in villus development are a consequence of defective trophoblast invasion and

Acknowledgments

We wish to acknowledge the contributions of the following individuals: Fiona Cody and Hilda O'Keeffe, Rotunda Hospital, Dublin; Cecelia Mulcahy, National Maternity Hospital, Dublin; Dr Casie Staehr and Emma Doolin, Coombe Women and Infants University Hospital, Dublin; Phyl Gargan, Royal Victoria Maternity Hospital, Belfast; Annette Burke, Galway University Hospital; Dr Richard Horgan and Marion Cunningham, Cork University Maternity Hospital; Debbie McCartan, Our Lady of Lourdes Hospital,

Cited by (0)

Supported by a research grant from the Health Research Board of Ireland.

The authors report no conflict of interest.

Cite this article as: Kent EM, Breathnach FM, Gillan JE, et al. Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT Study. Am J Obstet Gynecol 2012;207:220.e1-5.

View full text