Blickstein Isaac, Kalish Robin B
Dept. of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.
Twin Res. 2003 Dec;6(6):526-31. doi: 10.1375/136905203322686536.
This paper reviews several aspects of discordant growth in multiple pregnancies. Discordant growth is not a chance event and therefore several patterns can be discerned. About 75% of twins exhibit < 15% discordance (concordant), 20% are 15-25% (mildly) discordant, and about 5% are more than 25% (severely) discordant. Higher frequencies and increased severity are seen among triplets. Five observations regarding discordance became generally accepted: (a) not all discordant pairs are similar; (b) the larger the discordance level the greater is the risk for an adverse outcome; (c) discordant growth does not necessarily represent growth restriction; (d) a discordance level may have a different clinical implication in different gestational ages; and (e) the smaller fetuses in severely discordant pairs are at disproportionate risk for neonatal mortality. Mild discordance may represent a normal variation between sibs whereas severely discordant pairs often exhibit patterns of growth restriction. Not infrequently, discordance may represent an adaptation to the limited intrauterine space in order to increase gestational age.
本文综述了多胎妊娠中生长不一致的几个方面。生长不一致并非偶然事件，因此可以识别出几种模式。约75%的双胞胎生长不一致程度<15%（一致），20%为15 - 25%（轻度）不一致，约5%超过25%（重度）不一致。三胎妊娠中生长不一致的频率更高，严重程度也更高。关于生长不一致有五条观察结果已被普遍接受：（a）并非所有不一致的胎儿对都是相似的；（b）生长不一致程度越高，不良结局的风险越大；（c）生长不一致不一定代表生长受限；（d）在不同孕周，生长不一致程度可能有不同的临床意义；（e）在严重不一致的胎儿对中，较小的胎儿发生新生儿死亡的风险不成比例地增加。轻度生长不一致可能代表同胞之间的正常变异，而严重不一致的胎儿对通常表现出生长受限模式。生长不一致常常可能代表为延长孕周而对有限子宫内空间的一种适应。
