Placental pathology in birth weight discordant monochorionic and dichorionic twins

Identification of placental parenchymal lesions (PPL) associated with birth weight (BW) discordance will be helpful in understanding the pathogenesis of BW discordance in twins. The aim of this study was to evaluate such association in monochorionic (MC) and dichorionic (DC) twins. This was a single centre, prospective study of placentas of consecutive twin deliveries. Gross and microscopic examination of placentas were done according to a protocol. Association of PPL count with the degree of BW discordance and the significance of the presence of each PPL in the lighter twin (LT) in comparison to the heavier twin (HT) were analysed. Of the 92 placentas studied 57.6% were DC and 42.4% were MC. Significant BW discordance was present in 28% (n=39) of MC and 26% (n=53) of DC twins. There was a positive correlation with the PPL count of the LT and the mean BW discordance in both MC (p=0.032) and DC twins (p=0.043). Increased incidence of distal villous hypoplasia in the placental territory of the LT in comparison to the HT was statistically significant in BW-discordant DC twins (P=0.04) and in both BW-concordant and BW-discordant MC twins (p=0.02 and p=0.03 respectively). In conclusion, this single centre prospective study showed a strong association between the PPL count and the degree of BW discordance in both MC and DC twins. Increased incidence of distal villous hypoplasia in the placental territory of the LT in comparison to the HT was statistically significant.