Adverse neonatal outcome in twin pregnancy complicated by small‐for‐gestational age: twin <i>vs</i> singleton reference charts

Briffa, C.; Fabrizio, Carolina Di; Kalafat, Erkan; Giorgione, Veronica; Bhate, Rohan; Huddy, Charlotte; Richards, Justin; Shetty, Sandeep; Khalil, Asma

doi:10.1002/uog.23764

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…In this view, it could constitute a physiologic adaptation intrinsic in twins that would support the use of twins-specific charts to avoid misdiagnoses and unnecessary interventions, as recommended by many Authors. 13,[37][38][39][40] Interestingly, our findings on Doppler references resemble the phenomenon observed for growth curves, with quantitative differences with singletons from the early second trimester that become more pronounced after 30 gestational weeks.…”

Section: Discussionsupporting

confidence: 81%

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

et al. 2022

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Objectives: Monochorionic twins (MC) are at high risk of adverse outcomes and Doppler investigation of umbilical and cerebral flows is mandatory for their surveillance. The cerebro-placental (CPR) and umbilico-cerebral (UCR) ratios are considered non-invasive measures of fetal adaptation to hypoxemia. We aimed to provide longitudinal references for CPR and UCR from 16 to 37 weeks of gestation that are specific for MC twins, and compare these with singleton charts.Methods: Longitudinal study of a cohort of consecutive uncomplicated MC twin pregnancies monitored at our unit from 2010 to 2018. The estimated centile curves were obtained estimating the median with fractional polynomials by a multilevel model and the external centiles through the residuals. The comparison with singletons references was made through graphic evaluation.Results: One-hundred-fifty-two MC pregnancies were included with a median of 10 longitudinal ultrasounds each. References for CPR and UCR in function of gestational age are presented. Compared to singletons, MC twins showed an earlier and greater circulatory redistribution with lower CPR and higher UCR median values.Conclusions: MC twin-specific references for CPR and UCR suitable for serial monitoring are presented. The comparison with singleton references demonstrates substantial differences in the hemodynamic balance that must be considered when interpreting findings in MC twins. Key pointsWhat's already known about this topic? � Uncomplicated monochorionic twins have higher umbilical flow and lower cerebral flow resistances compared to singletons, especially at increasing gestational ages. What does this study add?� Monochorionic twins-specific longitudinal references for cerebro-placental and umbilicocerebral ratios from 16 to 37 weeks are reported.� Compared to singletons, uncomplicated monochorionic twins exhibit earlier and greater centralization of blood flow.Twins congress live online congress, 4-6 June 2021.

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Section: Discussionsupporting

confidence: 81%

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

et al. 2022

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“…Twin specific nomograms are less likely to diagnose SGA at birth [32]. In a recent study of 913 twin pregnancies, 79% of whom were dichorionic, using singleton growth charts classified approximately 35% as SGA at birth whereas only 5.6% were classified as SGA using twin-specific charts [30]. SGA designation using the twin-specific growth chart was also significantly associated with a composite adverse neonatal outcome [30].…”

Section: Should Twin Specific Growth Curves Be Used?mentioning

confidence: 98%

“…Given inherent differences in fetal growth between twins and singletons, twin specific growth charts and birthweight nomograms have been proposed. Twin-specific prenatal sonographic charts are less likely to diagnose twins with FGR and more likely to be associated with a composite adverse neonatal outcome when FGR is diagnosed [30]. For example, in a cohort of 806 twins, 52.4% were diagnosed with FGR in at least one using a singleton growth curve but only 16.9% were diagnosed with FGR when a twin growth curve was applied [31].…”

Section: Should Twin Specific Growth Curves Be Used?mentioning

confidence: 99%

Fetal growth disorders in twin gestations

Blumenfeld

Anderson

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTwin gestations account for approximately 3% of all births. Although there appear to be physiologic differences in the third trimester growth of twins compared with singleton gestations, reasons for this remain unclear. As growth-restricted fetuses and neonates are at increased risk for adverse outcomes, there is a clinical need to optimize our ability to delineate normally from pathologically grown twins.Recent findingsRecent studies have addressed current limitations in the way growth restriction is diagnosed in twin gestations. Twin-specific fetal and neonatal growth charts have been shown to decrease the number of cases inappropriately labeled as growth restricted compared with singleton nomograms. In addition, individual growth assessment (IGA) is a promising method of diagnosing pathological growth using each fetus's growth potential rather than a comparison of the estimated fetal weight with population nomograms.SummaryThere is a recent focus on improving our understanding of physiologic and pathologic twin growth. The increased use of twin-specific growth curves is likely to result in a decrease in the incidence of FGR diagnosis among twin gestations and could improve the outcomes of twins currently misclassified as FGR. Future research will hopefully clarify the reasons behind differences seen in twin versus singleton third trimester twin growth.

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“…Others suggest that the use of singleton percentile charts may cause a higher detection rate and thus stricter monitoring in pregnancies with an elevated risk of stillbirth [7]. According to recent studies, both prospective and retrospective, percentile charts individualized for twin pregnancies allow better selection of the population that is associated with a higher risk of perinatal morbidity and mortality [11][12][13]. Furthermore, the use of such charts allows the reduction of the population under strict antenatal surveillance as well as the avoidance of unnecessary interventions [14,15].…”

Section: Sfgr In Dichorionic Twin Pregnancy -Diagnosis and Managementmentioning

confidence: 99%

The role of estimated fetal weight discordance in dichorionic twin pregnancies

Kryczka,

Stepien,

Sawicki

2023

Ginekol Pol

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Evaluation of relative fetal growth in the form of estimated fetal weight discordance (EFWd) is a necessary element of any ultrasound examination in twin pregnancies. It is one of the criteria for the diagnosis of selective fetal growth restriction (sFGR) according to the most established worldwide guidelines. Apart from the effectiveness of this parameter for the diagnosis of sFGR, it may also be used as an independent factor for risk stratification of neonatal and maternal complications. Furthermore, numerous studies have proven the greater prognostic value of EFWd in dichorionic pregnancies, which may result from differences in the pathogenesis of fetal growth abnormalities in mono-and dichorionic pregnancies. Because of the variability of this parameter throughout pregnancy, there is an ongoing discussion regarding replacing or individualizing it with percentile charts. An additional element, complementary to EFWd in assessing the risk of complications in twin pregnancies is the use of this measurement in combination with Doppler assessment, which increases its predictive value. The use of EFWd as one of the factors influencing care and decision-making in dichorionic twin pregnancies seems to be a simple and effective method, however, further research assessing the use and possible applications of this indicator is necessary.

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Adverse neonatal outcome in twin pregnancy complicated by small‐for‐gestational age: twin vs singleton reference charts

Cited by 7 publications

References 30 publications

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

Fetal growth disorders in twin gestations

The role of estimated fetal weight discordance in dichorionic twin pregnancies

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