Prediction of outcome in twin pregnancy with first and early second trimester ultrasound

O’Connor, Clare; McAuliffe, Fionnuala M.; Breathnach, Fionnuala; Geary, Michael; Daly, Seán; Higgins, John R.; Dornan, James; Burke, Gerald; Higgins, Shane; Mooney, Eoghan E.; Manning, Fiona; McParland, Peter; Malone, Fergal D.

doi:10.3109/14767058.2013.766701

Cited by 25 publications

(22 citation statements)

References 17 publications

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“…64,65 One study (n = 960) assessed discordance in abdominal circumference (>10%), biparietal diameter (>10%), femur length (>10%), and estimated fetal weight (>10%) at 11–22 weeks of gestation as predictor for preterm birth at <34 weeks of gestation. 64 In general, the predictive accuracy of these biometric data was low with sensitivities, specificities, and positive and negative likelihood ratios that ranged from 7–51%, 71–96%, 1.5–3.1, and 0.7–1.0, respectively.…”

Section: Biophysical Testsmentioning

confidence: 99%

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Conde-Agudelo

Romero

2014

American Journal of Obstetrics and Gynecology

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The objective of this study was to determine the performance of biophysical and biochemical tests for the prediction of preterm birth in both asymptomatic and symptomatic women with twin gestations. We identified a total of 19 tests proposed to predict preterm birth, mainly in asymptomatic women. In these women, a single measurement of cervical length with transvaginal ultrasound before 25 weeks of gestation appears to be a good test to predict preterm birth. Its clinical potential is enhanced by the evidence that vaginal progesterone administration in asymptomatic women with twin gestations and a short cervix reduces neonatal morbidity and mortality associated with spontaneous preterm delivery. Other tests proposed for the early identification of asymptomatic women at increased risk of preterm birth showed minimal to moderate predictive accuracy. None of the tests evaluated in this review meet the criteria to be considered clinically useful to predict preterm birth among patients with an episode of preterm labor. However, a negative cervicovaginal fetal fibronectin test could be useful in identifying women who are not at risk for delivering within the next week, which could avoid unnecessary hospitalization and treatment. This review underscores the need to develop accurate tests for predicting preterm birth in twin gestations. Moreover, the use of interventions in these patients based on test results should be associated with the improvement of perinatal outcomes.

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Section: Biophysical Testsmentioning

confidence: 99%

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Conde-Agudelo

Romero

2014

American Journal of Obstetrics and Gynecology

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“…Este parámetro es aún más importante que la cigocidad 6,7 . Debemos tener en cuenta los siguientes aspectos.…”

Section: Diagnóstico De La Corionicidadunclassified

“…Sin embargo, la característica fundamental de los embarazos gemelares MC es la presencia de anastomosis vasculares placentarias, las cuales pueden ser arterio-arterial (AA), veno-venosa (VV) o arterio-venosa (AV) 5,6 ( Fig. 2).…”

Section: Figunclassified

“…Las comunicaciones AV/ VA son unidireccionales, una arteria de un gemelo irriga un cotiledón común de donde sale una vena que llega al otro feto. Si bien el recorrido de la arteria y vena son superficiales, el intercambio de sangre se realiza en los capilares del cotiledón, se les llama profundas 5 .Las anastomosis pueden ocasionar las complicaciones del MC por sí mismas o por combinación con otros factores, tales como discordancia de los territorios placentarios y/o malformaciones fetales 6 .…”

Section: Figunclassified

“…Se han utilizado también otros criterios como el de la circunferencia abdominal discordante superior al 10% 5 , que surgió de una cohorte que incluyó 1001 gestaciones enroladas en el estudio ESPRiT (Evaluation of Sonographic Predictors of Restrictedgrowth in Twins) 6 concluyendo que la diferencia mayor al 10% en la circunferencia abdominal se comportaba como un marcador de mal pronóstico perinatal. Otros lo consideran como la diferencia de tamaño entre ambos gemelos superior al 25% 7 ,obtenida mediante la fórmula:(Peso fetal estimado [PFE] del gemelo mayor -PFE del gemelo menor) x 100 / PFE del gemelo mayor 8 ,tomando como base un estudio retrospectivo de cohorte 8 que incluyo 2161 gestaciones gemelares de 9 centros asistenciales ingleses evaluados durante 10 años, determinando mediante regresión logarítmica y curva ROC, que la diferencia de peso superior a dicho valor aumentaba la mortalidad y morbilidad de ambos gemelos.…”

Section: Definicion Y Diagnosticounclassified

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Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Cosp

2016

Rev. Nac. (Itauguá)

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RESUMENLa Restricción Selectiva del Crecimiento Intrauterino se produce en 10 a 19% de los gemelos monocoriónicos y se asocia con un aumento importante de la mortalidad y la morbilidad perinatal. La evolución clínica está dada en gran parte por la presencia de anastomosis vaculares y la distribución placentaria asimétrica. Se propuso una clasificación en tres tipos según el Doppler de la arteria umbilical del gemelo más pequeño, la que sé que se correlaciona con distintos comportamientos clínicos y características de la placenta, lo que ayuda en el asesoramiento y conducta obstétrica. Los del tipo I tienen un pronóstico favorable por el resultado perinatal satisfactorio por lo que se recomienda un seguimiento cercano por ecografía y Doppler. Los de tipo II tienen un mal pronóstico y el tipo III un pronóstico intermedio e impredecible. En estos dos últimos se puede realizar un manejo expectante hasta que se observe deterioro del feto pequeño, considerando la posibilidad de la coagulación con láser o la oclusión del cordón (feticidio selectivo). Ambas conductas aparentemente aumentan las posibilidades de supervivencia del feto de peso normal.Palabras claves: restricción selectiva del crecimiento intrauterino, diagnóstico, manejo, gemelos monocoriales, doppler, terapia fetal ABSTRACT Selective intrauterine growth restriction occurs in 10-19% of monochorionic twins and is associated with increased mortality important and perinatal morbidity. The clinical course is given largely by the presence of placental vascular anastomosis and asymmetric distribution. It classified into three types according to the proposed Doppler umbilical artery smaller twin, the one that correlates with different clinical behaviors and characteristics of the placenta, which helps in counseling and obstetric conduct. The type I have a favorable prognosis for satisfactory perinatal outcome so closely monitored by ultrasound and Doppler is recommended. The type II has a poor prognosis and type III intermediate and unpredictable prognosis. In these last two you can make an expectant management until deterioration of the small fetus is observed, considering laser coagulation or cord occlusion(selective feticide). Both behaviors appear to increase the chances of survival of the fetus of normal weight.

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Ultrasound for diagnosis of birth weight discordance in twin pregnancies

Jahanfar

Jaafar

et al. 2021

Cochrane Database of Systematic Reviews

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Prediction of outcome in twin pregnancy with first and early second trimester ultrasound

Cited by 25 publications

References 17 publications

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Prediction of preterm birth in twin gestations using biophysical and biochemical tests

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Ultrasound for diagnosis of birth weight discordance in twin pregnancies

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