OC23.07: Maternal serum sFlt‐1; PlGF and sFlt‐1/PlGF ratio in the assessment of pre‐eclampsia in multifetal gestations: comparison to singleton pregnancies

Abstract

Oral communication abstracts OC23.05Inter-twin discordance in mean cerebral artery peak systolic velocity and pregnancy outcome in monochorionic diamniotic twin pregnancies Objectives: To assess the role of inter-twin discrepancy in middle cerebral artery peak systolic velocity (MCA-PSV) for the prediction of small for gestational age (SGA) and inter-twin growth discrepancy (ITGD) at birth in otherwise uncomplicated monochorionic diamniotic (MCDA) twin pregnancies. Methods: Cohort study on all MCDA pregnancies followed in a tertiary fetal medicine unit between 2008 and 2012. Exclusion criteria were: referral after 1st trimester, abnormal karyotype, structural anomalies, twin to twin transfusion syndrome, twin anemia-polycitemia sequence and selective fetal growth restriction with abnormal Umbilical Doppler. MCA-PSV values of both twins were converted in multiple of median (MoM). SGA was defined as birth weight <5th centile, ITGD was defined as a birth weight difference >25%. The relationship between MCA-PSV discrepancy, SGA and ITGD was assessed by logistic regression analysis. Receiver operating characteristic (ROC) curves were used to ascertain the predictive value of MCS-PSV discrepancy for such complications. Results: 117 MCDA twin pregnancies were included in the analysis. 42 (35.9%) had at least one SGA fetus; 13 (11.1%) were complicated with ITGD. Logistic regression analysis showed significant correlation between MCA-PSV discrepancy and both SGA (in the 2nd trimester OR 11.04; 95th CI 0.65−186.78; p = 0.09; in the 3rd trimester OR 110.47; 95th CI 6.12−1993.71; p < 0.001) and ITGD (in the 2nd trimester OR 101.11; 95th CI 1.65−6193.44; p < 0.03; in the 3rd trimester OR 309.28; 95th CI 4.32−22164.69; p < 0.01). Values were adjusted for maternal age, smoke and parity. ROC curves identified 3rd trimester MCA-PSV discrepancy as the best predictor for SGA (AUC 0.70, 95th CI 0.60−0.81; p < 0.001). The optimal cut off point was 0.30 MoM (Sens 0.64; Spec 0.76; LH + 2.68; LH-0.47). Conclusions: In MCDA twin pregnancies, MCA-PSV discrepancy is related to both SGA and ITGD at birth.