Twin growth discrepancy in early pregnancy

Bora, S. A.; Bourne, Tom; Bottomley, C.; Kirk, E.; Papageorghiou, Aris T.

doi:10.1002/uog.6422

Cited by 42 publications

(40 citation statements)

References 18 publications

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“…Current investigations found a significant correlation of fetal demise and discrepancy in CRL at the 11th-14th week scan in monochorionic twins (13). A difference in twins' CRL lengths <20% was usually found in twins that survived until due term, whereas when the CRL difference was >40%, a single loss was more common (14). In monochorionic twin pregnancies with a CRL discordance ≥ 10% the odds of birth weight discordance are three times higher than in concordant twins (8).…”

Section: Discussionmentioning

confidence: 89%

First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies

Aksam¹,

Plešinac²,

Dotlić³

et al. 2017

Turk J Med Sci

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The aim of the study was to evaluate the association and the potential predictive value of first trimester ultrasonographic parameters on the course and outcome of monochorionic diamniotic twin pregnancies. Materials and methods:A prospective cohort study was undertaken of 39 healthy women with consecutive monochorionic diamniotic twin pregnancies. During first-trimester screening, crown-rump length (CRL) and nuchal translucency (NT) were measured. The intertwin discordance in CRL and NT was determined. As pregnancy outcomes we assessed twins' live-born rates, Apgar scores, birth weight, pregnancy complications, and gestational week of delivery.Results: None of the assessed pregnancy outcomes significantly correlated with standard CRL discordance ≥10%. The newly established cut-off was 3.75 mm for CRL and 1.3 mm for NT. Monochorionic diamniotic twins were delivered in a later gestational week and had better chance of survival if CRL intertwin difference was <3.75 mm. Apgar scores significantly negatively correlated only with NT of corresponding twins. When intertwin NT difference was ≥1.3 mm, twins had lower birth weight and pregnancy complications were more frequent. Regression models show that intertwin CRL difference <3.75 mm is a significant predictor of live-born monochorionic diamniotic twins. Conclusion:CRL and NT in monochorionic diamniotic twin pregnancies could indicate pregnancy complications and outcomes.

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Section: Discussionmentioning

confidence: 89%

First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies

Aksam¹,

Plešinac²,

Dotlić³

et al. 2017

Turk J Med Sci

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“…There are controversial data whether twins have a higher FPR due to the increased incidence of enlarged NT measurements observed in monochorionic pregnancies, almost 1.5 times larger compared with dichorionic twins, as suggested by Sebire et al 37 and Cheng et al 38 It is thought that this increased fetal NT is an early manifestation of TTTS 28,29 ; however, this finding is not consistent in other studies, which have noted nonsignificant differences in mean NT measurements between dichorionic twins, monochorionic twins, and singletons. 35,39 FIRST-TRIMESTER SCREENING First-trimester aneuploidy screening combining NT with serum markers (free B-hCG and PAPP-A) is well established in singleton pregnancies, with a detection rate of 82% for Down syndrome with a 5% FPR.…”

Section: Ntmentioning

confidence: 98%

“…28 In fact, a discrepancy <20% had a likelihood of a subsequent viable twin pregnancy of 97%, whereas no viable twins were found at the 11-to 14-week scan when the discrepancy was >60%. This suggests that discrepancies in very early fetal stages may more accurately Prenatal Diagnosis in Multiples 565…”

Section: Identification Of Twin Gestations At Increased Risk For Compmentioning

confidence: 99%

First-trimester Ultrasound and Aneuploidy Screening in Multifetal Pregnancies

Hirshberg

Dugoff

2015

Clinical Obstetrics &Amp; Gynecology

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First-trimester ultrasound provides valuable information to help optimize the management of multifetal pregnancies. First trimester ultrasound the use of ultrasound and screening for aneuploidy has been well studied in singleton pregnancies. While evidence supporting the use of ultrasound in multiple gestations is well established, aneuploidy screening continues to evolve and its role in the prenatal setting has been less well studied. We review the importance of early first trimester ultrasound in assessing gestational age and chorionicity and early identification of anomalies, and review the various methods and limitations of aneuploidy screening and invasive diagnostic procedures in multiples.

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“…Several retrospective studies demonstrated that an intertwin CRL disparity identified early in the first trimester might predict several adverse perinatal outcomes or even fetal loss [31][32][33]. However, some of the studies excluded monochorionic gestations, whereas the majority of them included a relatively limited number of patients.…”

Section: Crown-rump Length Discordance and Perinatal Outcomementioning

confidence: 99%

“…135 Retrospective MC Not included 5-20% Shahshahan [43] 118 Prospective DC Not included 11% Fareeduddin [42] 78 Retrospective DC Not included 9% Bhide [39] 507 Retrospective MC and DC Included 12.2-19.3% Bora [32] 77 Retrospective MC and DC Included 16.9% Banks [41] 108 Retrospective DC Not included 5% Tai [40] 178 Retrospective MC and DC Not included 11.1% Salomon [37] 182 Prospective MC and DC Included 14.3%…”

mentioning

confidence: 99%

Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome

Kaponis

Thanatsis

Papadopoulos

et al. 2015

Journal of Perinatal Medicine

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Aim: In the current review study, we present recent data regarding the importance of intertwin estimated fetal weight (EFW) and crown rump length (CRL) discordance for the prediction of adverse perinatal outcome both in monochorionic and in dichorionic diamniotic gestations. Results: Twins with significant weight disparity are associated with higher rates of perinatal morbidity and mortality, regardless of gestational age at delivery. However, there is no agreement regarding as to the cut off value above which the perinatal outcome is unfavorably affected and the threshold range from 10 to 30%. On the other hand, CRL discrepancy has proved to be a weak predictor of adverse outcomes, such as fetal or neonatal death in fetuses without chromosomal and structural abnormalities. In clinical practice, decisions about obstetric surveillance of discordant twin gestations, frequency of fetal sonographic monitoring and time of delivery are usually based on amniotic fluid volume and Doppler assessments on a weekly basis. Conclusion: Significant EFW discordance leads to adverse perinatal outcome, although the cut-off value has not yet been estimated. CRL discrepancy is not correlated well with adverse perinatal outcome. However, increased monitoring of women with EFW and CRL discrepancy is suggested.

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Twin growth discrepancy in early pregnancy

Cited by 42 publications

References 18 publications

First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies

First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies

First-trimester Ultrasound and Aneuploidy Screening in Multifetal Pregnancies

Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome

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