Short- and long-term perinatal outcome in twin pregnancies affected by weight discordance.

INTRODUCTION: The objective was to investigate the association between chorionicity-specific intertwin birthweight discordance and adverse outcomes including long-term follow up at 6, 18, and 48-60 months after term via Ages and Stages Questionnaire. MATERIAL AND METHODS: In this secondary analysis of a cohort study (Oldenburg et al., n = 1688) and a randomized controlled trial (PREDICT study, n = 1045) twin pairs were divided into three groups according to chorionicity-specific birthweight discordance: <75th percentile, 75th-90th percentile and >90th percentile. Information on infant mortality, admittance to neonatal intensive care units, and gestational age at delivery was available for all pairs. Detailed neonatal outcomes were available for 656 pairs from PREDICT, of which 567 pairs had at least one Ages and Stages Questionnair follow-up. Logistic regression models were used for dichotomous outcomes. Ages and Stages Questionnair scores were compared using the method of generalized estimating equation to account for the correlation within twins. RESULTS: The 75th and 90th percentiles for birthweight discordance were 14.8 and 21.4% for monochorionic and 16.0 and 23.8% for dichorionic twins. After adjustment for small for gestational age and gender, birthweight discordance >75th and >90th percentile was associated with induced delivery <34 weeks [odds ratio 1.71 (95% confidence interval 1.11-2.65) and odds ratio 2.83 (95% confidence interval 1.73-4.64), respectively]. Discordance >75th-percentile was associated with an increased risk of infant mortality after 28 days [odds ratio 4.69 (95% confidence interval 1.07-20.45)] but not with major neonatal complications or with low mean Ages and Stages Questionnair scores at 6, 18, and 48-60 months after term. CONCLUSION: Chorionicity-specific intertwin birthweight discordance is a risk factor for induced preterm delivery and infant mortality, but not for lower scores for neurophysiological development at 6, 18, and 48-60 months.

Functional ovarian cysts in premenopausal and gynecologically healthy women.

The present study describes 29 women coincidentally found to have ovarian cysts while participating in a cross-sectional study. The prevalence of functional ovarian cysts is determined. In this study, 428 women, aged 14-45 years, were examined by transvaginal ultrasonography. The women were gynecologically healthy and were using either no contraception, intrauterine contraceptive devices, none of which were hormone releasing, or oral contraception (OC). Cysts were defined as cystic spaces larger than 30 mm. All women were asymptomatic and regularly menstruating.The prevalence of ovarian cysts was lower for women using OC than for women using no contraception or using intrauterine contraceptive devices. The relative risk (measured as the prevalence proportion ratio) of having an ovarian cyst when using OC was 0.22 (CI: 0.13-0.39), compared to women not using OC. No difference was found in the prevalence of ovarian cysts between women using intrauterine contraceptive devices and women using no contraception. The prevalence of ovarian cyst increased throughout the menstrual cycle in women not using OC. This relation was not found in the group of users of OC. The majority of the cysts resolved within the first few days of menstruation. Sixty-five percent of the cysts persisting after menstruation had resolved at the first control examination 3 months later, independently of use of OC. Low-dose monophasic contraceptive pills seem to have a protective effect against development of functional ovarian cysts, independent of the type of gestagen and the dose of ethinylestradiol used. Ovarian cysts resolved independently of treatment with OC. The use of intrauterine contraceptive device had no influence on the occurrence of functional ovarian cysts.