Archives of Gynecology and Obstetrics

, Volume 298, Issue 6, pp 1107–1114 | Cite as

The differences in placental pathology and neonatal outcome in singleton vs. twin gestation complicated by small for gestational age

  • Elad BarberEmail author
  • Eran Weiner
  • Ohad Feldstein
  • Ann Dekalo
  • Yossi Mizrachi
  • Damla Celen Gonullu
  • Jacob Bar
  • Letizia Schreiber
  • Michal Kovo
Maternal-Fetal Medicine



We aimed to compare placental histopathology and neonatal outcome between dichorionic diamniotic (DCDA) twins and singleton pregnancies complicated by small for gestational age (SGA).


Medical files and placental pathology reports from all deliveries between 2008 and 2017 of SGA neonates, (birthweight < 10th percentile), were reviewed. Comparison was made between singleton pregnancies complicated with SGA (singletons SGA group) and DCDA twin pregnancies (Twins SGA group), in which only one of the neonates was SGA. Placental diameters were compared between the groups. Placental lesions were classified into maternal and fetal vascular malperfusion lesions (MVM and FVM), maternal (MIR) and fetal (FIR) inflammatory responses, and chronic villitis. Neonatal outcome parameters included composite of early neonatal complications.


The twins SGA group (n = 66) was characterized by a higher maternal age (p = 0.011), lower gestational age at delivery (34.9 ± 3.1 vs. 37.7 ± 2.6 weeks, p < 0.001), and a higher rate of preeclampsia (p = 0.010), compared to the singletons SGA group (n = 500). Adverse composite neonatal outcome was more common in the twins SGA group (p < 0.001). Placental villous lesions related to MVM (p < 0.001) and composite MVM lesions (p = 0.04) were more common in the singletons SGA group. On multivariate logistic regression analysis, the singletons SGA group was independently associated with placental villous lesions (aOR 3.6, 95% CI 1.9–7.0, p < 0.001) and placental MVM lesions (aOR 2.44, 95% CI 1.29–4.61, p = 0.006).


Placentas from SGA singleton pregnancies have more MVM lesions as compared to placentas from SGA twin pregnancies, suggesting different mechanisms involved in abnormal fetal growth in singleton and twin gestations.


Small for gestational age Placental pathology Twin gestations Di-chorionic Di-amniotic 


Author contributions

EB: project development, data collection and management, data analysis, manuscript writing and editing. EW: project development, data analysis, manuscript writing and editing. OF: data collection and management. AD: data collection and management. YM: data analysis. DCG: data collection. JB: project development. LS: data analysis. MK: project development, data collection and management, data analysis, manuscript writing and editing.


There was no funding in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

Approval for the retrospective study was obtained from the local ethics committee and did not contain any procedures on human participants.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Department of Pathology, Wolfson Medical Center, Affiliated with Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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