The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes

Chen, Xinning; Zhou, Qionggui; Xiao, Xirong; Li, Xiaotian

doi:10.1007/s00404-018-5002-3

Cited by 6 publications

(8 citation statements)

References 61 publications

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“…Discordant growth to a certain degree may be inevitable, given that mild discordance may represent a normal variation between twin fetuses or an adaptation to limited intrauterine space [ 4 ]. However, severe growth discordance to a significant degree represents abnormal fetal growth and is associated with poor perinatal outcomes [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of different thresholds of birthweight discordance for early neonatal outcomes: retrospective analysis of 2348 twin pregnancies

Fan

et al. 2022

BMC Pregnancy Childbirth

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Background The optimal threshold of birthweight discordance (BWD) remains controversial. This study aimed to evaluate the associations between BWD at different thresholds and early neonatal outcomes and to assess their predictive accuracy. Methods This was a retrospective cohort study using a birthweight data with the chorionicity information of 2348 liveborn twin pairs at a gestational age of ≥26 weeks, from 2012 to 2018. The percentage of BWD was calculated by dividing the actual birthweight difference by the weight of the larger twin and multiplying by 100. Outcomes of interest included neonatal intensive care unit (NICU) admission, neonatal respiratory distress syndrome (NRDS), ventilator support and a composite outcome combining major morbidities and neonatal death. Logistic regression models were performed to estimate the association between neonatal outcomes and BWD with different thresholds (≥15.0%, ≥20.0%, ≥25% and ≥ 30%). Generalized estimated equation (GEE) models were used to address intertwin correlation. Restrictive cubic spline (RCS) models were established to draw the dose-response relationship between BWD and the odds ratios of outcomes. Clustered receiver operating characteristic (ROC) curve analyses were performed to assess the predictive accuracy. Results Of 2348 twin pairs, including 1946 dichorionic twin pairs and 402 monochorionic twin pairs, BWD was significantly associated with NICU admission, regardless of the thresholds used. The incidence of NRDS, ventilator support and the composite outcome were significantly higher when a threshold of ≥20% or greater was chosen. The dose-response relationship showed nonlinear growth in the risk of adverse neonatal outcomes with increasing BWD. ROC analyses showed a low significant AUROC of 0.569 (95% CI: 0.526–0.612) for predicting NICU admission but no significant AUROCs for predicting other outcomes. A BWD of ≥30% provided a moderate increase in the likelihood of NICU admission [positive likelihood ratio (LR+) = 5.77]. Conclusion Although BWD is independently associated with adverse neonatal outcomes, it is not a single predictor for neonatal outcomes given the weak discriminative ability to predict neonatal outcomes. A cutoff of 30% is more practical for risk stratification among twin gestations.

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Section: Introductionmentioning

confidence: 99%

Assessment of different thresholds of birthweight discordance for early neonatal outcomes: retrospective analysis of 2348 twin pregnancies

Fan

et al. 2022

BMC Pregnancy Childbirth

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“…Moreover, in some studies, even after adjusting for monochorionicity, the predictive value of using either second-trimester EFW or AC discordance did not improve [1,19]. These findings may be explained by the fact that discordant growth and other complications may appear only late in gestation [10]. In some investigations, growth restriction in fetuses was not detected in the second trimester.…”

Section: Discussionmentioning

confidence: 92%

“…Discordant growth between twins can be one of the signs of pregnancy complications that begin in the first half of pregnancy [9,10]. A strong link between intrauterine growth restriction and TTTS or stillbirth has been found in numerous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Abnormal biometry has been confirmed in the literature as an independent contributor to the poor prognosis of twins. Moreover, it seems that ultrasound parameters have better predictive ability in monochorionic twins [10]. Based on the available literature, the current study is one of the few that have investigated the ability of second-trimester ultrasound parameters to predict outcomes in monochorionic diamniotic twin pregnancies.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Monochorionic Diamniotic Twin Pregnancy Outcomes Based on Early Second Trimester Ultrasound

Aksam¹,

Dotlić²,

Belovic³

et al. 2023

Clin. Exp. Obstet. Gynecol.

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Background: Association between second trimester ultrasound findings and twin pregnancy outcome is still unclear. Study aimed to evaluate the performance of second trimester ultrasound scan in the prediction of monochorionic diamniotic twin pregnancies outcomes. Methods: Prospective-cohort study of all consecutive healthy women with monochorionic twin pregnancies followed-up and delivered in five years was undertaken. During second trimester screening (16-18 weeks) fetal biometry was measured (biparietal diameter-BPD, abdominal circumference-AC, femur length-FL, estimated fetal weight-EFW) and inter-twin discordance noted. Amniotic fluid amount was determined. Pregnancy outcomes were having live-born twins, Apgar sores and birth-weights, pregnancy complications and gestational week of delivery. Results: Receiver operating characteristics (ROC) analysis showed that BPD (p = 0.018), AC (p = 0.019) and FL (p = 0.015) were good predictors of having live-born twins. Regression analysis showed that the most important factors influencing twins' survival to term were inter-twin AC, BPD and FL differences. Fetal discordance in BPD, AC and FL explained correctly 76.3%, 76.5% and 58% of pregnancy outcomes. If second trimester inter-twin BPD difference was <2.5 mm, AC difference was <17 mm and FL difference was <1.5 mm survival of twins was better, complications were less frequent, delivery mostly occurred closer to term, twins had higher birth-weights and better Apgar scores. Second trimester EFW of twin and its difference as well as the amniotic fluid amount were not associated with examined pregnancy outcomes. Conclusions: Discordant twins' growth in the second trimester registered by ultrasound reliably implies on adverse monochorionic diamniotic twin pregnancy outcome.

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“…The predictive value of fetal growth parameters include crown-lump length (CRL), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Estimated fetal weight (EFW) is calculated using empirical formulas based on the above parameters [8][9][10]. However, some disadvantages of conventional predictive indicators cannot be overlooked.…”

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confidence: 99%

Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: A retrospective cohort study

Zhou

et al. 2023

Preprint

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Background Accurate prenatal recognition of discordant fetal growth in twins is critical for deciding suitable management strategies. We explored the predictive value of the level of maternal second-trimester placental growth factor (PLGF) as a novel indicator of discordant fetal growth. Methods A total of 860 women pregnant with twins were enrolled, including 168 women with monochorionic twins (31 cases of discordant fetal growth and 137 without) and 692 with dichorionic twins (79 cases of discordant fetal growth and 613 without). Maternal second-trimester PLGF concentrations were measured via immunofluorescence. Results Maternal second-trimester PLGF levels were significantly lower in women pregnant with twins who subsequently developed discordant fetal growth than in those who did not (monochorionic twin pregnancy: P < 0.001; dichorionic twin pregnancy: P < 0.001). A 3–4 fold difference in median PLGF concentrations was detected between the two groups with both monochorionic and dichorionic twin pregnancies. Maternal second-trimester PLGF levels were significantly correlated with birth weight differences (monochorionic twin pregnancy: r = − 0.331, P < 0.001; dichorionic twin pregnancy: r = − 0.234, P < 0.001). A receiver operating characteristic curve was used to evaluate the predictive efficiency. In monochorionic twin pregnancies, the area under the curve (AUC) was 0.751 (95% confidence interval [CI]: 0.649–0.852), and the cutoff value was 187.5 pg/mL with a sensitivity of 77.4% and specificity of 71.0%. In dichorionic twin pregnancies, the AUC was 0.716 (95% CI; 0.655–0.777), and the cutoff value was 252.5 pg/mL with a sensitivity of 65.1% and specificity of 69.6%. Based on the above cutoff values, univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (OR) for the PLGF levels. After adjustment for potential confounding factors, low PLGF concentrations still significantly increased the risk of discordant fetal growth (monochorionic twin pregnancy: adjusted OR: 7.039, 95% CI: 2.798–17.710, P < 0.001; dichorionic twin pregnancy: adjusted OR: 4.279, 95% CI: 2.572–7.120, P < 0.001). Conclusions A low maternal second-trimester PLGF level is considered a remarkable risk factor and potential predictor of discordant fetal growth. This finding provides a complementary screening strategy for the prediction of discordant fetal growth and offers a unique perspective for the subsequent research in this field.

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The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes

Cited by 6 publications

References 61 publications

Assessment of different thresholds of birthweight discordance for early neonatal outcomes: retrospective analysis of 2348 twin pregnancies

Assessment of different thresholds of birthweight discordance for early neonatal outcomes: retrospective analysis of 2348 twin pregnancies

Prediction of Monochorionic Diamniotic Twin Pregnancy Outcomes Based on Early Second Trimester Ultrasound

Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: A retrospective cohort study

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