CONTRIBUTIONWhat are the novel findings of this work? This study of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation and no major abnormalities, first, compares overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5 th percentile between dichorionic, monochorionic diamniotic and monochorionic monoamniotic twins, and, second, examines the potential impact of endoscopic laser surgery for severe twin-twin transfusion syndrome and/or selective fetal growth restriction on the outcome of monochorionic diamniotic twins. What are the clinical implications of this work?In twin pregnancy, determination of chorionicity and amnionicity at the routine 11-13-week scan is essential because this defines the subsequent pregnancy outcome and the need for surveillance and intervention. ABSTRACTObjectives To report and compare pregnancy outcome in dichorionic (DC), monochorionic diamniotic (MCDA) and monochorionic monoamniotic (MCMA) twin pregnancies with two live fetuses at 11-13 weeks' gestation and to examine the impact of endoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) and/or selective fetal growth restriction (sFGR) on the outcome of MCDA twins.Methods This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. In pregnancies with no major abnormalities, we compared overall survival, fetal loss at < 24 weeks' gestation, perinatal death at ≥ 24 weeks, delivery at < 37 and < 32 weeks, and birth weight < 5 th percentile between DC, MCDA and MCMA twins. ResultsThe study population of 6225 twin pregnancies with two live fetuses at 11-13 weeks' gestation with no major abnormalities included 4896 (78.7%) DC, 1274 (20.5%) MCDA and 55 (0.9%) MCMA twins. In DC twins, the rate of loss at < 24 weeks' gestation in all fetuses was 2.3%; this rate was higher in MCDA twins (7.7%; relative risk (RR), 3.258; 95% CI, and more so in MCMA twins (21.8%; RR, 9.289; 95% CI,). In DC twins, the rate of perinatal death at ≥ 24 weeks in all twins that were alive at 24 weeks was 1.0%; this rate was higher in MCDA twins (2.5%; RR, 2.456; 95% CI,) and more so in MCMA twins (9.3%; RR, 9.130; 95% CI,. In DC twins, the rate of preterm birth at < 37 weeks' gestation in pregnancies with at least one liveborn twin was 48.6%; this rate was higher in MCDA twins (88.5%; RR, 1.824; 95% CI, 1.760-1.890) and more so in MCMA twins (100%; RR, 2.060; 95% CI, 2.000-2.121). In DC twins, the rate of preterm birth at < 32 weeks was 7.4%; this rate was higher in MCDA twins (14.2%; RR, 1.920; 95% CI,) and more so in MCMA twins (26.8%; RR, 3.637; 95% CI,. In DC twin pregnancies with at least one liveborn twin, the rate of a small-for-gestational-age neonate among all liveborn twins was 31.2% and in MCDA twins this rate was higher (37.8%; RR, 1.209; 95% CI,; in MCMA twins, the rate was not significantly different (33.3%; RR, 1.067; 95...

Objective To investigate the potential value of uterine artery pulsatility index (UtA‐PI) and serum levels of the angiogenic placental growth factor (PlGF) and the antiangiogenic factor soluble fms‐like tyrosine kinase‐1 (sFlt‐1) in the prediction of adverse perinatal outcome in small‐for‐gestational‐age (SGA) and non‐SGA neonates at 35–37 weeks' gestation. Methods This was a prospective observational study of 19 209 singleton pregnancies attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, sonographic estimation of fetal weight, color Doppler ultrasound for measurement of mean UtA‐PI, and measurement of serum concentrations of PlGF and sFlt‐1. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal or pregnancy characteristics and measurements of UtA‐PI, PlGF and sFlt‐1 provided a significant contribution in the prediction of each of four adverse outcome measures: first, stillbirth; second, Cesarean delivery for suspected fetal compromise in labor; third, neonatal death or hypoxic ischemic encephalopathy Grade 2 or 3; and, fourth, admission to the neonatal unit (NNU) for ≥ 48 h. Predicted probabilities from logistic regression analysis were used to construct receiver–operating characteristics curves to assess the performance of screening for these adverse outcomes. Results First, 83% of stillbirths, 82% of Cesarean sections for presumed fetal compromise in labor, 91% of cases of neonatal death or hypoxic ischemic encephalopathy and 86% of NNU admissions for ≥ 48 h occurred in pregnancies with a non‐SGA neonate. Second, UtA‐PI > 95th percentile, sFlt‐1 > 95th percentile and PlGF < 5th percentile were associated with increased risk of Cesarean delivery for suspected fetal compromise in labor and NNU admission for ≥ 48 h; the number of stillbirths and cases of neonatal death or hypoxic ischemic encephalopathy was too small to demonstrate significance in the observed differences from cases without these adverse outcomes. Third, multivariable logistic regression analysis demonstrated that, in the prediction of Cesarean delivery for suspected fetal compromise in labor, there was no significant contribution from biomarkers; the prediction of NNU admission for ≥ 48 h by maternal demographic characteristics and medical history was only marginally improved by the addition of sFlt‐1 or PlGF. Fourth, for each biomarker, the detection rate of adverse outcome was higher in SGA than in non‐SGA neonates, but this increase was accompanied by an increase in false‐positive rate. Fifth, the relative risk of UtA‐PI > 95th, sFlt‐1 > 95th and PlGF < 5th percentiles for most adverse outcomes was < 2.5 in both SGA and non‐SGA neonates. Conclusions In pregnancies undergoing routine antenatal assessment at 35–37 weeks' gestation, measurements of UtA‐PI, sFlt‐1 or PlGF provide poor prediction of adverse perinatal outcome in both SGA and non‐SGA fetuses. Copyright © 20...

What are the novel findings of this work? Sonographic estimated fetal weight (EFW) at mid-gestation can improve the prediction of early and preterm pre-eclampsia (PE) provided by maternal risk factors and mean arterial pressure (MAP) but not the prediction provided by a combination of maternal risk factors, MAP and uterine artery pulsatility index. What are the clinical implications of this work?In pregnancies complicated by preterm PE, a high proportion of babies are small-for-gestational age and EFW measured at the routine mid-gestation ultrasound examination can be used for prediction of preterm PE.