%0 Journal Article
%T Discordant twins with the smaller baby appropriate for gestational age ¨C unusual manifestation of superfoetation: A case report
%A Noopur Baijal
%A Mohit Sahni
%A Neeraj Verma
%A Amit Kumar
%A Nittin Parkhe
%A Jacob M Puliyel
%J BMC Pediatrics
%D 2007
%I BioMed Central
%R 10.1186/1471-2431-7-2
%X The first of twins was of 32 weeks gestation and the baby was of appropriate size and development for the gestational age. The second twin was of 36 weeks gestation. Gestational age was estimated with the New Ballard score, x-ray of the lower limbs, dental age on x-ray, and ophthalmic examination.Bleeding on implantation of the first foetus probably helped demarcate the two pregnancies. Dental age and the New Ballard score can be used to diagnose superfoetation in discordant twins, when detailed first trimester ultra-sound data is not available.Superfoetation implies fertilization and subsequent development of an ovum when a foetus is already present in the uterus. Growth discordance in multiple pregnancies due to placental insufficiency, twin to twin transfusion or aneuploidy need to be differentiated from superfoetation. In most instances the larger twin is nearer appropriate size for gestational age calculated from the last menstrual period (LMP). We report a case where superfoetation was likely superfoetationbecause the smaller of the twin was of appropriate maturity, weight and length for gestational age. These circumstances argued against intrauterine growth retardation in the smaller twin.A 21-year-old mother of two had an ante-natal ultrasound examination done 26 weeks after her last menstrual period (LMP). This showed twins, one was of appropriate size for duration of amenorrhoea while the other was approximately four weeks too large. The ultrasound findings are described in Table 1.Six weeks later, after 32 weeks of amenorrhoea, live twins were delivered. They had not received ante-natal steroids. The first of the twins (Twin A) weighed 980 grams and the next baby (Twin B) weighed 2160 grams. Detailed neurological assessment using the New Ballard Scoring [1], was done on the second day. The score for Twin A was 15, pointing to a gestational age of 30 weeks (+/- 2 weeks) and the score for Twin B was 32, appropriate for 36 weeks (+/- 2 weeks). Table 2 lists
%U http://www.biomedcentral.com/1471-2431/7/2