The influence of birth order and presentation on intrauterine growth of twins.

In order to evaluate the influence of birth order and fetal presentation on antenatal growth of twins we conducted a comparison of prospective measurements of five fetal biometric indices in 50 vertex-vertex and 47 vertex-breech twins. We compared (a) twin A to twin B in both groups; (b) the second and (c) the first twins of both groups. Both groups had similar maternal and neonatal characteristics. The growth curves of the twins were also very similar except for three significant (p < 0.05) deviations: (a) Twin A of the vertex-vertex group, had larger femur length (FL) at 18-19 weeks, abdominal circumference (AC) and estimated fetal weight (EFW) at 29 weeks, and EFW measurements at 36 weeks. (b) Second breech twins, compared to their second vertex cohorts, had significantly smaller biparietal diameter (BPD), head circumference (HC) and FL at 18-19 weeks, BPD and HC at 29 weeks, and EFW at 37 weeks. (c) First twins of the vertex-breech group, as compared to first twins of the vertex-vertex group, had significantly smaller BPD and AC at 18-19 weeks, FL and AC at 21-22 and 29 weeks, FL at 31 weeks, and EFW at 27-28 and 36 weeks' gestation. We concluded that significantly different sonographic fetal indices may be measured at about 20 and 30 weeks' gestation, but not later. An adaptive mechanism attributed to fetal presentation is suggested to explain similar birthweights in spite of these antepartum differences.