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Deater-Deckard K. Is Self-Regulation "All in the family"? Testing Environmental Effects using Within-Family Quasi-Experiments. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016; 40:224-233. [PMID: 27110046 PMCID: PMC4836863 DOI: 10.1177/0165025415621971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most of the individual difference variance in the population is found within families, yet studying the processes causing this variation is difficult due to confounds between genetic and nongenetic influences. Quasi-experiments can be used to test hypotheses regarding environment exposure (e.g., timing, duration) while controlling for genetic confounds. To illustrate, two studies of cognitive self-regulation in childhood (i.e., working memory [WM], effortful control [EC], attention span/persistence [A/P]) are presented. Study 1 utilized an identical twin differences design (N = 85 to 98 pairs) to control for genetic differences while using relative twin birth weight difference to predict relative twin difference in WM and EC. Larger relative twin difference in WM and EF was predicted by the combination of shorter gestation and larger relative birth weight difference. Study 2 utilized an adoptive sibling relative difference design (N = 123 same-sex pairs) to control for genetic similarity while using relative sibling difference in the age at time of adoption to predict relative sibling difference in A/P. Larger relative sibling difference in A/P was predicted by the combination of larger relative difference in time in the adoptive home and age at adoption. Within-family quasi-experimental designs allow stronger inferences about hypothesized environmental influences than between-family designs permit.
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Shen CL, Zhang Q, Meyer Hudson J, Cole FS, Wambach JA. Genetic Factors Contribute to Risk for Neonatal Respiratory Distress Syndrome among Moderately Preterm, Late Preterm, and Term Infants. J Pediatr 2016; 172:69-74.e2. [PMID: 26935785 PMCID: PMC4876036 DOI: 10.1016/j.jpeds.2016.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/14/2015] [Accepted: 01/06/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the genetic contribution to risk for respiratory distress syndrome (RDS) among moderately preterm, late preterm, and term infants (estimated gestational age ≥32 weeks) of African- and European-descent. STUDY DESIGN We reviewed clinical records for 524 consecutive twin pairs ≥32 weeks gestation. We identified pairs in which at least 1 twin had RDS (n = 225) and compared the concordance of RDS between monozygotic and dizygotic twins. Using mixed-effects logistic regression, we identified covariates that increased disease risk. We performed additive genetic, common environmental, and residual effects modeling to estimate genetic variance and used the ratio of genetic variance to total variance to estimate genetic contribution to RDS disease risk. RESULTS Monozygotic twins were more concordant for RDS than dizygotic twins (P = .0040). Estimated gestational age, European-descent, male sex, delivery by cesarean, and 5-minute Apgar score each independently increased risk for RDS. After adjusting for these covariates, genetic effects accounted for 58% (P = .0002) of the RDS disease risk variance for all twin pairs. CONCLUSIONS In addition to environmental factors, genetic factors may contribute to RDS risk among moderately preterm, late preterm, and term infants. Discovery of risk alleles may be important for prediction and management of RDS risk.
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Affiliation(s)
- Carol L Shen
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Qunyuan Zhang
- Center for Genome Sciences and Systems Biology, Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO
| | - Julia Meyer Hudson
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - F Sessions Cole
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Jennifer A Wambach
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
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Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon LJ, Sotiriadis A, Thilaganathan B, Ville Y. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:247-63. [PMID: 26577371 DOI: 10.1002/uog.15821] [Citation(s) in RCA: 351] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 05/27/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - M Rodgers
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Baschat
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Bhide
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - E Gratacos
- Fetal Medicine Units and Departments of Obstetrics, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germaniy
| | - M D Kilby
- Centre for Women’s and Children's Health, University of Birmingham and Fetal Medicine Centre, Birmingham Women’s Foundation Trust, Birmingham, UK
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, UK
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - K Reed
- Twin and Multiple Births Association (TAMBA)
| | - L J Salomon
- Hopital Necker-Enfants Malades, AP-HP, Universit´e Paris Descartes, Paris, France
| | - A Sotiriadis
- Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B Thilaganathan
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - Y Ville
- Hospital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
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Discordance in fetal biometry and Doppler are independent predictors of the risk of perinatal loss in twin pregnancies. Am J Obstet Gynecol 2015; 213:222.e1-222.e10. [PMID: 25731693 DOI: 10.1016/j.ajog.2015.02.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/17/2015] [Accepted: 02/19/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Impaired fetal growth might be better evaluated in twin pregnancies by assessing the intertwin discordance rather than the individual fetal size. The aim of this study was to investigate the prediction of perinatal loss in twin pregnancy using discordance in fetal biometry and Doppler. STUDY DESIGN This was a retrospective cohort study in a tertiary referral center. The estimated fetal weight (EFW), umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), and their discordance recorded at the last ultrasound assessment before delivery or demise of one or both fetuses were converted into centiles or multiples of the median (MoM). The discordance was calculated as the larger value-smaller value/larger value. A logistic regression analysis was performed to identify, and adjust for, potential confounders. The predictive accuracy was assessed using receiver-operating characteristic curve analysis. RESULTS The analysis included 620 (464 dichorionic diamniotic and 156 monochorionic diamniotic) twin pregnancies (1240 fetuses). Perinatal loss of one or both fetuses complicated 16 pregnancies (2.6%). The combination of EFW discordance and CPR discordance had the best predictive performance (area under the curve, 0.96; 95% confidence interval, 0.92-1.00) for perinatal mortality. The detection rate, false-positive rate, positive likelihood ratio, and negative likelihood ratio were 87.5%, 6.7%, 13.08, and 0.13, respectively. The EFW centile, EFW below the 10th centile (small for gestational age), UA PI discordance, MCA PI discordance, and MCA PI MoM were significantly associated with the risk of perinatal loss on univariate analysis, but these associations became nonsignificant after adjusting for other confounders (P = .097, P = .090, P = .687, P = .360, and P = .074, respectively). The UA PI MoM, CPR MoM, EFW discordance, and CPR discordance were all independent predictors of the risk of perinatal loss, even after adjusting for potential confounders (P = .022, P = .002, P < .001, and P = .010, respectively). CONCLUSION EFW discordance and CPR discordance are independent predictors of the risk of perinatal loss in twin pregnancies. Their combination could identify the majority of twin pregnancies at risk of perinatal loss. These findings highlight the importance of discordance in Doppler indices of fetal hypoxia, as well as fetal size, in assessing the risk of perinatal mortality.
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Stirrup OT, Khalil A, D'Antonio F, Thilaganathan B. Fetal growth reference ranges in twin pregnancy: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:301-7. [PMID: 25052857 DOI: 10.1002/uog.14640] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/24/2014] [Accepted: 07/14/2014] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To generate reference charts for expected fetal growth in dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twin pregnancies and to compare these with those from singleton pregnancies. METHODS This was a retrospective study of biometric measurements from serial ultrasound examinations of twin pregnancies in the second and third trimesters, from 14 weeks' gestation to term, collected by nine hospitals over a 10-year period. The measurements obtained in each fetus at each examination included head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL). Multilevel mixed effects statistical models were used to evaluate growth in each biometric variable in relation to gestational age, taking account of the serial examinations and the association between the two fetuses in each pregnancy, with separate models constructed for DCDA and MCDA pregnancies. RESULTS The final dataset for analysis included a total of 9866 second- and third-trimester ultrasound examinations in 1802 DCDA and 323 MCDA twin pregnancies, with a median of five (range, 1-14) scans per pregnancy. For each variable, the mean value for DCDA twins was close to the reported value in singletons at 20-30 weeks and showed a decrease relative to singletons beyond 30 weeks. The differences were greater for AC and HC, for which the mean in twins was approximately equivalent to the 30th percentile in singletons at 18 weeks, the 35th percentile at 25 weeks and the 30th percentile at 35 weeks. Fetuses in MCDA twin pregnancies displayed lower mean measurements than did those in DCDA pregnancies throughout the gestational age range considered. CONCLUSIONS Ultrasound biometry shows a small but statistically significant reduction in fetal growth in twin pregnancies relative to that in singletons, particularly in the third trimester, with a more marked difference for MCDA than for DCDA pregnancies.
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Affiliation(s)
- O T Stirrup
- MRC Clinical Trials Unit at UCL, University College London, London, UK
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56
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D'Antonio F, Khalil A, Morlando M, Thilaganathan B. Accuracy of Predicting Fetal Loss in Twin Pregnancies Using Gestational Age-Dependent Weight Discordance Cut-Offs: Analysis of the STORK Multiple Pregnancy Cohort. Fetal Diagn Ther 2015; 38:22-8. [DOI: 10.1159/000369326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
Objectives: A third-trimester fetal weight discordance of 25% has been proposed as an independent predictor of fetal loss in twin pregnancies. As fetal weight gain at this stage of pregnancy increases exponentially, it is not entirely certain whether a single cut-off for inter-twin weight discordance is appropriate. The aim of this study was to investigate whether a single weight discordance cut-off can be used or whether different cut-offs should be adopted according to the gestational age at assessment. Methods: This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort over a 10-year period. Receiver operating characteristic curve and logistic regression analyses were used to explore the relation between estimated fetal weight (EFW) discordance detected within 4 weeks from the occurrence of the outcome and single fetal loss at different gestational age windows. Results: 957 twin pregnancies (173 monochorionic and 784 dichorionic) were included in the analysis. EFW discordance was independently associated with the occurrence of single fetal loss in twin pregnancies in each gestational age window. Ultrasound EFW discordance had an area under the curve of 0.77 (95% CI: 0.67-0.87) for the prediction of single fetal loss in the third trimester of pregnancy, with an optimal cut-off of around 25% (23.2%). The optimal cut-offs of EFW discordance for the prediction of single fetal loss were different in each gestational age window. Conclusion: The accuracy of EFW discordance in predicting single fetal loss in twin pregnancies varies during the third trimester of pregnancy. The degree of fetal weight discordance associated with fetal loss decreases during the third trimester, suggesting that the weight discordance threshold for intervention should vary according to gestational age.
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Khalil A, D'Antonio F, Dias T, Cooper D, Thilaganathan B. Ultrasound estimation of birth weight in twin pregnancy: comparison of biometry algorithms in the STORK multiple pregnancy cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:210-220. [PMID: 24311473 DOI: 10.1002/uog.13253] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/10/2013] [Accepted: 11/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aims of this study were first, to ascertain the accuracy of formulae for ultrasonographic birth-weight estimation in twin compared with singleton pregnancies and second, to assess the accuracy of sonographic examination in the prediction of birth-weight discordance in twin pregnancies. METHODS This was a retrospective cohort study including both singleton and twin pregnancies. Routine biometry was recorded and estimated fetal weight (EFW) calculated using 33 different formulae. Only pregnancies that delivered within 48 h of the ultrasound scan were included (4280 singleton and 586 twin fetuses). Differences between the EFW and actual birth weight (ABW) were assessed by percentage error, accuracy in predictions within ± 10% and ± 15% of error and use of the Bland-Altman method. The accuracy of prediction of the different cut-offs of birth-weight discordance in twin pregnancies was also assessed using the area under the receiver-operating characteristics curve (AUC). RESULTS The overall mean absolute percentage error was ≤ 10% for 25 formulae in singleton pregnancies compared with three formulae in twin pregnancies. The overall predictions within ± 10% and ± 15% of the ABW were 62.2% and 81.5% in singleton and 49.7% and 68.5% in twin pregnancies, respectively. When t e formulae were categorized according to the biometric parameters included, those based on a combination of head, abdomen and femur measurements showed the lowest mean absolute percentage error, in both singleton and twin pregnancies. The predictive accuracy for 25% birth-weight discordance using the Hadlock 2 formula, as assessed by the AUC, was 0.87. CONCLUSIONS Ultrasound estimation of birth weight is less accurate in twin than in singleton pregnancies. Formulae that include a combination of head, abdomen and femur measurements perform best in both singleton and twin pregnancies.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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D'Antonio F, Khalil A, Pagani G, Papageorghiou AT, Bhide A, Thilaganathan B. Crown-rump length discordance and adverse perinatal outcome in twin pregnancies: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:138-146. [PMID: 24585501 DOI: 10.1002/uog.13335] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/28/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this systematic review was to explore the relationship between crown-rump length (CRL) discordance detected at 11-14 weeks of gestation and adverse outcome in twin pregnancy and to assess its predictive accuracy. METHODS A protocol designed a priori following MOOSE guidelines and recommended for systematic review and meta-analysis was used. The outcomes observed were: total fetal and perinatal loss, fetal loss at <24 weeks, fetal loss at ≥ 24 weeks, birth-weight (BW) discordance, preterm delivery (PTD) at < 34 weeks and fetal anomalies. The analysis was performed for all twins and for dichorionic (DC) and monochorionic (MC) twins separately. RESULTS A total of 2008 articles were identified and 17 studies were included in the systematic review. Twin pregnancies with CRL discordance ≥ 10% were at significantly higher risk of perinatal loss (RR, 2.80; 95% CI, 1.25-6.27; P = 0.012), fetal loss at ≥ 24 weeks (RR, 4.07; 95% CI, 1.47-11.23; P = 0.006), BW discordance (RR, 2.24; 95% CI, 1.89-2.64; P < 0.001) and PTD at < 34 weeks (RR, 1.49; 95% CI, 1.23-1.80; P < 0.001) but not of fetal loss at < 24 weeks (P = 0.130). A meta-analysis of fetal anomalies was not possible because fewer than two studies explored this outcome. However, when used alone to screen for adverse pregnancy outcome, the predictive accuracy of CRL discordance was low for each of the outcomes explored. CONCLUSION CRL discordance is associated with an increased risk of adverse pregnancy outcome. However, the accuracy of CRL discordance in predicting adverse outcome is poor and thus limits its routine use in clinical practice.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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Optimal antenatal care for twin and triplet pregnancy: The evidence base. Best Pract Res Clin Obstet Gynaecol 2014; 28:305-17. [DOI: 10.1016/j.bpobgyn.2013.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/06/2013] [Accepted: 12/10/2013] [Indexed: 11/21/2022]
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Sueters M, Oepkes D. Diagnosis of twin-to-twin transfusion syndrome, selective fetal growth restriction, twin anaemia-polycythaemia sequence, and twin reversed arterial perfusion sequence. Best Pract Res Clin Obstet Gynaecol 2014; 28:215-26. [DOI: 10.1016/j.bpobgyn.2013.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/11/2013] [Accepted: 12/03/2013] [Indexed: 11/26/2022]
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Thilaganathan B, Khalil A. Multiple pregnancy: preface. Best Pract Res Clin Obstet Gynaecol 2014; 28:189-90. [PMID: 24388730 DOI: 10.1016/j.bpobgyn.2013.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/11/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Basky Thilaganathan
- Fetal Medicine Unit, St. George's Healthcare NHS Trust, Department of Obstetrics and Gynaecology, 4th Floor, Lanesborough Wing, Blackshaw Road, London SW17 0QT, United Kingdom.
| | - Asma Khalil
- Fetal Medicine Unit, St. George's Healthcare NHS Trust, Department of Obstetrics and Gynaecology, 4th Floor, Lanesborough Wing, Blackshaw Road, London SW17 0QT, United Kingdom
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Lewi L, Devlieger R, De Catte L, Deprest J. Growth discordance. Best Pract Res Clin Obstet Gynaecol 2013; 28:295-303. [PMID: 24361179 DOI: 10.1016/j.bpobgyn.2013.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/25/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
Poor growth is a common problem in twin pregnancies, and management poses some unique challenges as the wellbeing of both twins have to be taken into account at all times. The decision to deliver the twins to prevent an intrauterine demise of the growth-restricted twin will, therefore, depends on the chances of intact postnatal survival of both twins. In monochorionic twins, management is complicated further by the fact that the wellbeing of one twin critically depends on that of the other twin because of the shared circulation. In the event of demise of the growth-restricted twin, the larger twin may also die or sustain brain damage because of an acute exsanguination into the feto-placental unit of its demised co-twin. In the pre-viable period, invasive fetal therapy may, therefore, be indicated to protect the appropriately growing twin.
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Affiliation(s)
- Liesbeth Lewi
- Fetal Medicine Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Roland Devlieger
- Fetal Medicine Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Luc De Catte
- Fetal Medicine Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Deprest
- Fetal Medicine Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
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D'Antonio F, Khalil A, Thilaganathan B. Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG 2013; 121:422-9. [PMID: 24308510 DOI: 10.1111/1471-0528.12467] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine the association between biometry discordance at the time of the anomaly scan and adverse perinatal outcomes in twin pregnancies. DESIGN Retrospective cohort study. SETTING Nine hospitals in the Southwest Thames Region of London Obstetric Research Collaborative (STORK). POPULATION OR SAMPLE Population multicentre retrospective study of all twin pregnancies booked for antenatal care in nine hospitals over a period of 10 years. Methods Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between abdominal circumference (AC) and estimated fetal weight (EFW) discordance, recorded between 20 and 22 weeks of gestation, and adverse pregnancy outcomes. MAIN OUTCOME MEASURES Stillbirth, neonatal mortality, preterm birth (PTB) at <34 weeks of gestation, and birthweight (BW) discordance ≥25%. RESULTS A total of 2399 twin pregnancies [457 monochorionic (MC) and 1942 dichorionic (DC)] were included in the study. The predictive accuracy of the EFW discordance was poor for fetal loss after 22 weeks of gestation (area under the curve, AUC 0.54, 95% CI 0.46-0.64), fetal loss beyond 28 weeks of gestation (AUC 0.42, 95% CI 0.31-0.52), perinatal loss (AUC 0.51, 95% CI 0.44-0.57), BW discordance (AUC 0.63, 95% CI 0.56-0.65), and PTB before 34 weeks of gestation (AUC 0.52, 95% CI 0.49-0.55). There was no significant difference in the prediction of these outcomes when using EFW discordance or AC discordance. CONCLUSIONS Once structural malformations, chromosomal abnormalities, and twin-to-twin transfusion syndrome have been excluded, second-trimester EFW and AC discordance have poor predictive value for adverse perinatal outcomes in twin pregnancy.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's, University of London, London, UK
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64
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Lewi L, Deprest J. Management of twin pregnancies: where do we go from here? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:601-604. [PMID: 23712884 DOI: 10.1002/uog.12502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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