Ultrasound in Twin Pregnancies

Morin, Lucie; Lim, Kenneth; Bly, Sara; Butt, Kimberly; Cargill, Yvonne; Davies, Gregory; Denis, Nathalie; Gagnon, Robert; Hietala-Coyle, Marja Anne; Ouellet, Annie; Salem, Shia; Senikas, Vyta; Barrett, Jon; Wilson, R. Douglas; Audibert, François; Brock, Jo-Ann; Carroll, June C.; Cartier, Lola; Gagnon, Alain; Johnson, Jo-Ann; Langlois, Sylvie; Murphy-Kaulbeck, Lynn; Okun, Nanette; Pastuck, Melanie; Hudon, Lynda; Basso, Melanie; Bos, Hayley; Crane, Joan; Delisle, Marie-France; Menticoglou, Savas; Mundle, William; Pressey, Tracy; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank

doi:10.1016/j.ijgo.2011.07.001

Cited by 19 publications

(47 citation statements)

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“…The degree of intertwin discordance in EFW is often used to identify pregnancies in which there is abnormal growth, with commonly recommended cut-offs of 20% [2] or 25% [1] . One study found that a cut-off of 18% for discordance in birthweight optimally predicted adverse outcome, and hence suggested that this lower value should be used [3] .…”

Section: Main Findingsmentioning

confidence: 99%

“…For example, the model developed predicts 104 that a 20% cut-off for intertwin discordance in EFW would select 3.0% of DCDA pregnancies at 20 weeks but 7.6% at 30 weeks, and for MCDA pregnancies the proportions would be 8.1% and 13.6%, respectively. One guidelines document, published by the Society of Obstetricians and Gynaecologists of Canada, suggests that an absolute difference in AC of greater than 20 mm can be used to define abnormal growth discordance [2] . However, considering DCDA pregnancies, the present analysis demonstrates that this cut-off varies from being equivalent to the 98th percentile at 20 weeks to being only around the 83rd percentile at 30 weeks.…”

Section: Main Findingsmentioning

confidence: 99%

“…Twin pregnancies are affected by higher rates of complications than singleton pregnancies and so are managed with relatively increased prenatal surveillance, including serial ultrasound scans for the assessment of fetal well-being and growth [1,2] . As for singleton pregnancies, each individual fetus in a twin pregnancy can be assessed in comparison to growth standards for uncomplicated pregnancies [2] , but their development may be better assessed by the evaluation of intertwin differences.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of Second- and Third-Trimester Growth and Discordance in Twin Pregnancy: Analysis of the Southwest Thames Obstetric Research Collaborative (STORK) Multiple Pregnancy Cohort

Stirrup

Khalil²,

D’Antonio³

et al. 2016

Fetal Diagn Ther

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Introduction: This study investigates patterns of intertwin size discordance in dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twin pregnancies. Material and Methods: Ultrasound measurements of twin pregnancies, from 14 weeks to term, were collected by 9 hospitals over a 10-year period. This analysis considers the modelled and observed levels of discordance in abdominal circumference (AC) and estimated fetal weight (EFW) in relation to gestational age. Fitted models were analysed to produce charts displaying the expected range of intertwin discordance in AC and EFW at any given examination. Results: The dataset for analysis included a total of 9,866 ultrasound examinations in 1,802 DCDA and 323 MCDA twin pregnancies. The 95th percentile of intertwin discordance in EFW increased from 18.3% (95% CI, 17.8-18.7%) at 20 weeks to 21.9% (95% CI, 21.3-22.4%) at 30 weeks for DCDA pregnancies. The 95th percentile for intertwin discordance in AC was stable at 10-11% for this period. Slightly higher levels of discordance were observed for MCDA than for DCDA pregnancies. Discussion: The expected range of intertwin discordance in EFW and AC shows differences with gestational age and between DCDA and MCDA pregnancies.

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Section: Main Findingsmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patterns of Second- and Third-Trimester Growth and Discordance in Twin Pregnancy: Analysis of the Southwest Thames Obstetric Research Collaborative (STORK) Multiple Pregnancy Cohort

Stirrup

Khalil²,

D’Antonio³

et al. 2016

Fetal Diagn Ther

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“…Although there are multiple publications on an increased morbidity and mortality rates with discordant growth, there is a paucity of reports on how to manage them optimally and deliver them in a timely manner. Morin and Lim reviewed the literature with respect to the use of diagnostic ultrasound in the management of twin pregnancies (Morin & Lim, 2011). They suggested that growth discordance might be defined using either a difference (20 mm) in absolute measurement in abdominal circumference or a difference of 20% in the ultrasound-derived estimated fetal weight.…”

Section: Discussionmentioning

confidence: 99%

Blood Flow Changes in Dichorionic Twins With Growth Discordance

2012

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Aim: The study evaluated the applicability of Doppler ultrasonography in predicting the course of pregnancy and neonatal outcome in dichorionic pregnancy complicated by growth discordance. Methods: Doppler examination of the umbilical artery (UA) and middle cerebral artery (MCA) was performed in 106 twins. Abnormal values of the UA pulsatility index (PI) were considered to be above the 95th percentile and below 5th percentile for the MCA PI for gestational week. The difference of UA PI ≥0.5 in twin pairs was considered abnormal. Doppler results were compared with selected parameters that characterize the course of pregnancy and fetal outcome. Results: Abnormal UA PI as well as the intertwine PI difference of 0.5 and more correlated significantly with lower gestational age at delivery, intertwine growth discordance of 35% or more, lower birth weight, and abnormal fetal outcome. The abnormal cerebro-umbilical (C/U) ratio correlated statistically with lower birth weight, abnormal fetal outcome, and an increased risk of premature delivery. There were no statistically significant differences in the majority of parameters that characterize the neonatal outcome between the groups with normal and abnormal MCA PI. Conclusion: The intertwine UA PI difference ≥0.5 had the highest predictive value in the assessment of adverse fetal outcome and risk for small for gestational age (SGA). Relatively poor sensitivity was noted with regard to the abnormal values of UA PI and C/U ratio. The worse correlation was found in case of MCA PI.

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“…Most international guidelines now recommend 2-3 weekly ultrasound assessment from 16 weeks (Emery et al, 2015;Fisk et al, 2009;Morin & Lim, 2011;Royal College of Obstetricians and Gynaecologists, 2008). Nevertheless, there is little data on the speed of development of TTTS or the efficacy of the frequency of monitoring in MC twins.…”

Section: Predictionmentioning

confidence: 99%

Future Directions in the Management of Twin-to-Twin Transfusion Syndrome

Cincotta¹,

Kumar

2016

Twin Res Hum Genet

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Twin-to-twin transfusion syndrome (TTTS) is the major complication of monochorionic (MC) pregnancy. The outcomes of this condition have been significantly improved after the introduction and widespread uptake of fetoscopic laser ablation over the last decade. However, there is still a significant fetal loss rate and morbidity associated with this condition. Improvements in the management of TTTS will require improvements in many areas. They are likely to involve refinements in the prediction of the disease and clarification of the optimum frequency of surveillance and monitoring. Improvements in training for fetoscopic surgery as well as in the technique of fetoscopic laser ablation may lead to better outcomes. New technologies as well as a better understanding of the pathophysiology of TTTS may lead to adjuvant medical therapies that may also improve short- and long-term results.

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Ultrasound in Twin Pregnancies

Cited by 19 publications

References 0 publications

Patterns of Second- and Third-Trimester Growth and Discordance in Twin Pregnancy: Analysis of the Southwest Thames Obstetric Research Collaborative (STORK) Multiple Pregnancy Cohort

Patterns of Second- and Third-Trimester Growth and Discordance in Twin Pregnancy: Analysis of the Southwest Thames Obstetric Research Collaborative (STORK) Multiple Pregnancy Cohort

Blood Flow Changes in Dichorionic Twins With Growth Discordance

Future Directions in the Management of Twin-to-Twin Transfusion Syndrome

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