Vol 95, No 5 (2024)
Review paper
Published online: 2023-10-24

open access

Page views 326
Article views/downloads 239
Get Citation

Connect on Social Media

Connect on Social Media

The role of estimated fetal weight discordance in dichorionic twin pregnancies

Mateusz Kryczka1, Mateusz G. Stepien1, Wlodzimierz Sawicki1
Pubmed: 37934897
Ginekol Pol 2024;95(5):408-413.


Evaluation of relative fetal growth in the form of estimated fetal weight discordance (EFWd) is a necessary element of any ultrasound examination in twin pregnancies. It is one of the criteria for the diagnosis of selective fetal growth restriction (sFGR) according to the most established worldwide guidelines. Apart from the effectiveness of this parameter for the diagnosis of sFGR, it may also be used as an independent factor for risk stratification of neonatal and maternal complications. Furthermore, numerous studies have proven the greater prognostic value of EFWd in dichorionic pregnancies, which may result from differences in the pathogenesis of fetal growth abnormalities in mono- and dichorionic pregnancies. Because of the variability of this parameter throughout pregnancy, there is an ongoing discussion regarding replacing or individualizing it with percentile charts. An additional element, complementary to EFWd in assessing the risk of complications in twin pregnancies is the use of this measurement in combination with Doppler assessment, which increases its predictive value. The use of EFWd as one of the factors influencing care and decision-making in dichorionic twin pregnancies seems to be a simple and effective method, however, further research assessing the use and possible applications of this indicator is necessary.

Article available in PDF format

View PDF Download PDF file


  1. Stirrup OT, Khalil A, D'Antonio F, et al. STORK. Patterns of second- and third-trimester growth and discordance in twin pregnancy: analysis of the southwest thames obstetric research collaborative (STORK) multiple pregnancy cohort. Fetal Diagn Ther. 2017; 41(2): 100–107.
  2. Di Mascio D, Acharya G, Khalil A, et al. Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2019; 98(10): 1245–1257.
  3. D'Antonio F, Odibo AO, Prefumo F, et al. Weight discordance and perinatal mortality in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018; 52(1): 11–23.
  4. Khalil A, Beune I, Hecher K, et al. Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure. Ultrasound Obstet Gynecol. 2019; 53(1): 47–54.
  5. Khalil A, Lewi L, Lopriore E. Twin and Higher-order Pregnancies. Springer International Publishing, Cham 2021.
  6. Kim HMi, Cha HH, Seong WJ, et al. Prediction of maternal complications and neonatal outcome in dichorionic diamniotic twins with fetal weight discordancy measured by ultrasonography. Sci Rep. 2022; 12(1): 14889.
  7. Khalil A, Rodgers M, Baschat A, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016; 47(2): 247–263.
  8. Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies: ACOG Practice Bulletin, Number 231. Obstet Gynecol. 2021; 137(6): e145–e162.
  9. Antonakopoulos N, Pateisky P, Liu B, et al. Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome. J Clin Med. 2020; 9(5).
  10. Stirrup OT, Khalil A, D'Antonio F, et al. Southwest Thames Obstetric Research Collaborative (STORK). Fetal growth reference ranges in twin pregnancy: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol. 2015; 45(3): 301–307.
  11. Briffa C, Di Fabrizio C, Kalafat E, et al. Adverse neonatal outcome in twin pregnancy complicated by small-for-gestational age: twin vs singleton reference charts. Ultrasound Obstet Gynecol. 2022; 59(3): 377–384.
  12. Shea SK, Likins BJ, Boan AD, et al. Dichorionic twin-specific vs singleton growth references for diagnosis of fetal growth restriction. Am J Obstet Gynecol. 2021; 224(6): 603.e1–603.e9.
  13. Nowacka U, Kosińska-Kaczyńska K, Krajewski P, et al. Predictive accuracy of singleton versus customized twin growth chart for adverse perinatal outcome: a cohort study. Int J Environ Res Public Health. 2021; 18(4).
  14. Kalafat E, Sebghati M, Thilaganathan B, et al. Southwest Thames Obstetric Research Collaborative (STORK). Predictive accuracy of Southwest Thames Obstetric Research Collaborative (STORK) chorionicity-specific twin growth charts for stillbirth: a validation study. Ultrasound Obstet Gynecol. 2019; 53(2): 193–199.
  15. Hiersch L, Barrett J, Fox NS, et al. Should twin-specific growth charts be used to assess fetal growth in twin pregnancies? Am J Obstet Gynecol. 2022; 227(1): 10–28.
  16. D'Antonio F, Khalil A, Morlando M, et al. Accuracy of predicting fetal loss in twin pregnancies using gestational age-dependent weight discordance cut-offs: analysis of the STORK multiple pregnancy cohort. Fetal Diagn Ther. 2015; 38(1): 22–28.
  17. Amyx MM, Albert PS, Bever AM, et al. Intrauterine growth discordance across gestation and birthweight discordance in dichorionic twins. Am J Obstet Gynecol. 2020; 222(2): 174.e1–174.e10.
  18. Gelman M, Wilkof-Segev R, Gawie-Rotman M, et al. Abdominal circumference discordance for prediction of small for gestational age at birth in twin pregnancies. J Matern Fetal Neonatal Med. 2022; 35(18): 3573–3578.
  19. Algeri P, Frigerio M, Lamanna M, et al. Selective IUGR in dichorionic twins: what can Doppler assessment and growth discordancy say about neonatal outcomes? J Perinat Med. 2018; 46(9): 1028–1034.
  20. van de Waarsenburg MK, Hack KEA, Rijpma RJ, et al. Ultrasonographic prediction of birth weight discordance in twin pregnancies. Prenat Diagn. 2015; 35(9): 906–912.
  21. Hehir MP, Breathnach FM, Hogan JL, et al. Prenatal prediction of significant intertwin birthweight discordance using standard second and third trimester sonographic parameters. Acta Obstet Gynecol Scand. 2017; 96(4): 472–478.
  22. Chen X, Zhou Q, Xiao X, et al. The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes. Arch Gynecol Obstet. 2019; 299(2): 459–468.
  23. Halling C, Malone FD, Breathnach FM, et al. Perinatal Ireland Research Consortium. Neuro-developmental outcome of a large cohort of growth discordant twins. Eur J Pediatr. 2016; 175(3): 381–389.
  24. Goyen TA, Veddovi M, Lui K. Developmental outcome of discordant premature twins at 3 years. Early Hum Dev. 2003; 73(1-2): 27–37.
  25. Kim MiJu, Kim HMi, Cha HH, et al. Perinatal outcomes and neurodevelopment 1 year after birth in discordant twins according to chorionicity. Medicina (Kaunas). 2023; 59(3).
  26. Giorgione V, Bhide A, Bhate R, et al. Are twin pregnancies complicated by weight discordance or fetal growth restriction at higher risk of preeclampsia? J Clin Med. 2020; 9(10).
  27. Qiao P, Zhao Y, Jiang X, et al. Impact of growth discordance in twins on preeclampsia based on chorionicity. Am J Obstet Gynecol. 2020; 223(4): 572.e1–572.e8.
  28. Sparks TN, Nakagawa S, Gonzalez JM. Hypertension in dichorionic twin gestations: how is birthweight affected? J Matern Fetal Neonatal Med. 2017; 30(4): 380–385.
  29. Zhu J, Zhang J, Wu Yi, et al. Intertwin growth discordance throughout gestation and hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2023; 228(6): 730.e1–730.e13.
  30. Cao X, Luo Ye, Zhou S, et al. Twin growth discordance and risk of postpartum hemorrhage: a retrospective cohort study. Front Med (Lausanne). 2022; 9: 876411.
  31. Lees CC, Stampalija T, Baschat A, et al. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol. 2020; 56(2): 298–312.
  32. Vanlieferinghen S, Anselem O, Le Ray C, et al. Prognostic value of umbilical and cerebral Doppler in fetal growth restriction: comparison of dichorionic twins and singletons. PLoS One. 2015; 10(4): e0123067.
  33. Kibel M, Kahn M, Sherman C, et al. Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies. Placenta. 2017; 60: 28–35.
  34. Khalil AA, Khan N, Bowe S, et al. Discordance in fetal biometry and Doppler are independent predictors of the risk of perinatal loss in twin pregnancies. Am J Obstet Gynecol. 2015; 213(2): 222.e1–222.e10.