Impact of head-to-abdominal circumference asymmetry on outcomes in growth-discordant twins

Jodi S. Dashe, Donald D. McIntire, Rigoberto Santos-Ramos, Kenneth J. Leveno

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


OBJECTIVE: Our aim was to evaluate head-to-abdominal circumference asymmetry as a marker for adverse outcomes in growth-discordant twins. STUDY DESIGN: We conducted a retrospective cohort study of asymmetric and symmetric twins with ≥25% growth discordance, comparing their outcomes with those in concordant symmetric twins. Growth was termed asymmetric on the basis of a head circumference/abdominal circumference ratio at ≥95th percentile on ultrasonography performed ≤4 weeks before delivery. RESULTS: We evaluated 572 twin pairs. Asymmetric discordant twins were more likely than symmetric concordant twins to be delivered at ≤34 weeks' gestation (57% vs 27%), to require intubation (36% vs 7%), to remain in intensive care > 1 week (36% vs 3%), and to have an outcome composite that included respiratory morbidity, intraventricular hemorrhage, sepsis, or neonatal death (29% vs 6%), all P < .05. Symmetric discordant and symmetric concordant twins had similar outcomes. CONCLUSIONS: Discordant twins with head-to-abdominal circumference asymmetry have an increased risk of morbidity. Moreover, in the absence of asymmetry, outcomes are comparable among discordant and concordant twins.

Original languageEnglish (US)
Pages (from-to)1082-1087
Number of pages6
JournalAmerican journal of obstetrics and gynecology
Issue number5
StatePublished - 2000


  • Growth-discordant twins
  • Head-to-abdominal circumference asymmetry

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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