Prenatal assessment of fetal growth during a multiple pregnancy according to the type of placentation

Kostyukov K.V.

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia
Growth restriction of one or both fetuses during a multiple pregnancy is one of the main causes of perinatal losses. The development of specialized normative scales for estimated fetal weight for monochorionic and dichorionic twins will be able to diagnose more accurately this pregnancy complication.
Objective. To assess the features of fetal growth during a multiple pregnancy according to the type of chorionicity and to develop normative scales for estimated fetal weight.
Material and methods. A total of 578 uncomplicated multiple pregnancies (128 with monochorionic and 450 with dichorionic twins delivered after 34 weeks’ gestation, who underwent echographic studies and calculation of estimated fetal weight.
Results. A total of 1,156 fetuses underwent 5,286 fetometric studies. Regardless of chorionicity, the twin fetal growth trend is not linear - there is weight gain acceleration, starting in the second trimester, which lasts until the end of pregnancy. The mean fetal weight in dichorionic twins was higher than that for monochorionic twins, beginning at 30 weeks’ gestation.
Conclusion. The developed normative scales and percentiles charts of estimated weight for different types of placentation will contribute to the improved prenatal assessment of fetal growth in a multiple pregnancy. The revealed difference in fetal growth in uncomplicated mono- and dichorionic twins will be able to reduce the false-positive rate for the diagnosis of selective growth retardation syndrome.


multiple pregnancy
monochorionic twin
dichorionic twin
estimated fetal weight
prenatal diagnosis


  1. Martin J.A., Hamilton B.E., Osterman M.J. Three decades of twin births in the United States, 1980-2009. NCHS Data Brief. 2012; 1–8. PMID: 22617378
  2. Blickstein I. Normal and abnormal growth of multiples. Semin Neonatol 2002; 7: 177–85. doi: 10.1053/siny.2002.0105
  3. Hack K.E., Derks J.B., Elias S.G., et al. Increased perinatal mortality and morbidity in mono- chorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008; 115: 58–67. doi: 10.1111/j.1471-0528.2007.01556.x
  4. Alexander G., Kogan M., Martin J., Papiernik E. What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clin Obstet Gynecol. 1998; 41: 115–25. doi: 10.1097/00003081-199803000-00017
  5. Joseph K.S., Fahey J., Platt R.W., et al. An outcome-based approach for the creation of fetal growth standards: do singletons and twins need separate standards? Am J Epidemiol. 2009; 169: 616–24. doi: 10.1093/aje/kwn374
  6. Sankilampi U., Hannila M.L., Saari A., Gissler M., Dunkel L. New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks. Ann Med. 2013; 45: 446–54. doi: 10.3109/07853890.2013.803739.
  7. Gielen M., Lindsey P.J., Derom C., et al. Twin- specific intrauterine ‘growth’ charts based on cross-sectional birthweight data. Twin Res Hum Genet. 2008; 11: 224–35. doi: 10.1375/twin.11.2.224.
  8. Hutcheon J.A., Platt R.W. The missing data problem in birth weight percentiles and thresholds for “small for gestational age.” Am J Epidemiol. 2008; 167: 786–92. doi: 10.1093/aje/kwm327.
  9. Hadlock F.P., Harrist R.B., Sharman R.S., Deter R..L, Park S.K. Estimation of fetal weight with the use of head, body, and femur measurements—a prospective study. Am J Obstet Gynecol. 1985; 151: 333–7. doi: 10.1016/0002-9378(85)90298-4
  10. Liao A.W., Brizot Mde L., Kang H.J., Assuncao R.A., Zugaib M. Longitudinal reference ranges for fetal ultrasound biometry in twin pregnancies. Clinics. 2012; 67: 451–5. doi: 10.6061/clinics/2012(05)08
  11. Min S.J., Luke B., Gillespie B., et al. Birth weight references for twins. Am J Obstet Gynecol. 2000; 182: 1250–7. doi: 10.1067/mob.2000.104923 ·
  12. O’Brien W.F., Knuppel R.A., Scerbo J.C., Rattan P.K. Birth weight in twins: an analysis of discordancy and growth retardation. Obstet Gynecol. 1986; 67: 483e6. PMID: 3515254
  13. Lewi L., Jani J., Blickstein I., Huber A., et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol. 2008; 199: 514.e1e8. doi: 10.1016/j.ajog.2008.03.050.
  14. American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013; 121: 1122–33. doi: 10.1097/01.AOG.0000429658.85846.f9.
  15. Dunsworth H.M., Warrener A.G., Deacon T., Ellison P.T., Pontzer H. Metabolic hypothesis for human altriciality. Proc Natl Acad Sci USA. 2012; 109: 15212–6. doi: 10.1073/pnas.1205282109
  16. Kalafat E., Sebghati M., Thilaganathan B., Khalil A. Predictive accuracy of Southwest Thames Obstetric Research Collaborative (STORK) chorionicity-specific twin growth charts for stillbirth: a validation study Ultrasound Obstet Gynecol 2019; 53: 193–199 doi: 10.1002/uog.19069

Received 17.09.2019

Accepted 04.10.2019

About the Authors

Kirill V. Kostyukov, MD, Ph.D., Senior Researcher, Department of Fetal Medicine, Institute of Obstetrics, Doctor of Functional and Ultrasound Diagnostics, Department of Visual Diagnostics, Federal State Budgetary Institution National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakova of the Ministry of Health of Russia, e-mail:
117997, Russia, Moscow, ul. Ak. Oparina, d. 4.

For citation: Kostyukov K.V. Prenatal assessment of fetal growth during a multiple pregnancy according to the type of placentation.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 2: 88-96.(In Russian).

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