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Antunes M, Matias A. Association between first-trimester uterine artery Doppler and crown-rump length with growth discordance: does it make a difference. J Perinat Med 2024; 52:638-644. [PMID: 38753440 DOI: 10.1515/jpm-2024-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The purpose of this study was to investigate the association between first-trimester uterine artery pulsatility index (UtA-PI) and crown-rump length discordance (CRLD) with growth discordance (GD) in twins and analyze the influence of chorionicity in these parameters. METHODS This retrospective analysis integrated data from the twin pregnancy database of Centro Hospitalar São João (2019-2023), including 184 fetuses, with 19 monochorionic and 73 dichorionic gestations. To determine the association between UtA-PI and CRLD with GD, correlation analyses were computed and linear regression models were carried out. Separate analyses were conducted for each type of placentation. Logistic regression analysis was carried out to determine the association of mean UtA-PI and CRLD with severe GD, defined as discordance ≥25 %. RESULTS GD≥25 % was detected in 9.80 % of pregnancies. A statistically significant difference between monochorionic and dichorionic gestations was found in crown-rump length (p=0.009), CRLD (p<0.001) and birth weight (p=0.025), but not in mean UtA-PI (p=0.853) or GD (p=0.556). Mean UtA-PI was significantly higher in discordant than in concordant pairs (p<0.001), but that association was not seen in CRLD (p=0.931). Mean UtA-PI and GD were correlated by the regression line "GD=3.844 × UtA-PI + 6.638", with R2 0.027. CRLD and GD were correlated by the regression line "GD=0.280 × CRLD + 10.79", with R2 0.010. Mean UtA-PI, but not CRLD, was significantly associated with severe GD (odds ratio, 22.753; p=0.002). CONCLUSIONS Mean UtA-PI, but not CRLD, is associated with GD. The prevalence of severe GD increases significantly with increasing mean UtA-PI.
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Affiliation(s)
- Maria Antunes
- Faculty of Medicine, 26705 University of Porto , Porto, Portugal
| | - Alexandra Matias
- Obstetrics and Gynecology, Faculty of Medicine, 26705 University of Porto , Porto, Portugal
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Barati M, Najafian M, Saadati N, Motefares M. Investigation of the Association of Abdominal Circumference Discord-ance and Estimated Fetal Weight Discordance in Twins with Birth Weight Discordance. Med J Islam Repub Iran 2024; 38:30. [PMID: 38803389 PMCID: PMC11129283 DOI: 10.47176/mjiri.38.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Indexed: 05/29/2024] Open
Abstract
Background Twin pregnancy is associated with a high risk of mortality and morbidity. It is necessary to estimate the weight difference of the fetuses with a reliable method to prevent possible complications. This study was conducted to compare the association between the Estimated fetal weight (EFW) discord-ance and the Abdominal Circumference (AC) discordance with birth weight in twins. Methods This was a descriptive-analytical and retrospective study. The statistical population was all twin pregnant mothers referred to Imam Khomeini Hospital in Ahvaz from 2017 to 2019. The sample size was determined with a census (540 people). Based on AC , the size of head circumference (HC), femur length (FL), and the Biparietal Diameter (BPD), EFW was calculated. Then the EFW Dis-cordance and AC Discordance were calculated and compared with the birth weight. Data were analyzed using SPSS18. Unpaired, Two-Tailed T-test and Pearson correlation test were used. Results The results showed that the mean discordance of fetal weight in twin pregnancies in the EFW method was 9.25%, in the AC method was 9.89% and finally, at birth, was 10.72%. The correla-tion of the weight difference between the two embryos in the AC method with the time of birth (r = 0.922 and P < 0.001) was higher than in the EFW method with the time of birth (r = 0.69 and P < 0.001) and finally, it was found that in detecting the discordance more than 20% and 25%, AC diagnostic power was good, but EFW was moderate. Conclusion Therefore, to evaluate the weight and weight difference in twin embryos, the AC method has the appropriate accuracy and compatibility. Another major prospective study to evaluate the diagnostic performance of AC and EFW mismatch based on gestational age at scan, incision point, and maternal and placental characteristics to determine true ultrasound diagnostic accuracy in predict-ing growth mismatch in twin pregnancy and optimal post-case management option is needed.
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Affiliation(s)
- Mojgan Barati
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmieh Saadati
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Motefares
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xiang H, Huang X, Zhu J, Chen J, Zhou P, Zhou T, Bao J, Xu Z. Physical growth and intelligence development of discordant dizygotic twins from birth to preschool age: a prospective cohort study. Ital J Pediatr 2022; 48:162. [PMID: 36064427 PMCID: PMC9446820 DOI: 10.1186/s13052-022-01354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The majority of studies are limited to adverse perinatal outcomes and poor cognitive abilities in the short term in discordant monochorionic twins. Methods To determine whether small and large discordant dizygotic twins differ in physical growth and intelligence development and weight and height from birth up to 6 years of age were measured in 34 dizygotic twin pairs with ≥ 20% birth weight discordance. Mental developmental index (MDI) and psychomotor developmental index (PDI) were calculated at 1 year, while the Wechsler Intelligence Scale for Children-IV (WISC-IV) full-scale intelligence quotient (IQ) was assessed at the age of 6. Results The difference in height and weight in each stage differed significantly from birth to 72-months-old (P < 0.05), although there was disappointing catch-up growth in smaller twins. PDI but not MDI at 1 year of age was significantly different between the two groups (P < 0.05), and smaller twins experienced higher psychomotor retardation rates (P < 0.05). Also, the influence of height and weight on PDI was statistically significant (P < 0.05). No significant difference was detected in the WISC-IV full-scale IQ at the age of 6; however, the full-scale IQ may be affected by the history of suffocation and the S/D value (P = 0.011, P = 0.022). Conclusions Intrauterine fetal growth and development lead to birth weight differences in twins and sustain an impact on the children’s physical growth in height and weight from birth to preschool age, causing psychomotor developmental differences at 1 year of age. However, the differences in psychomotor development decrease gradually by the age of 6. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-022-01354-y.
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Affiliation(s)
- Huiqiu Xiang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Xianping Huang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Jing Zhu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Jiajia Chen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Pangpang Zhou
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Tong Zhou
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Jiale Bao
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China
| | - Zhangye Xu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, People's Republic of China.
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Ye S, Fan D, Li P, Chen G, Rao J, Zhang H, Zhou Z, Feng J, Luo C, Guo X, Liu Z, Lin D. Assessment of different thresholds of birthweight discordance for early neonatal outcomes: retrospective analysis of 2348 twin pregnancies. BMC Pregnancy Childbirth 2022; 22:93. [PMID: 35105310 PMCID: PMC8808974 DOI: 10.1186/s12884-022-04417-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04417-4.
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Affiliation(s)
- Shaoxin Ye
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Pengsheng Li
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Jiaming Rao
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Huishan Zhang
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zixing Zhou
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Jinping Feng
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Caihong Luo
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
| | - Dongxin Lin
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
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Lei T, Zheng J, Papageorghiou AT, Feng JL, Lin MF, Zhang F, Xie HN. Ultrasound in the prediction of birthweight discordance in dichorionic twins. Acta Obstet Gynecol Scand 2021; 100:908-916. [PMID: 33253418 DOI: 10.1111/aogs.14055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Large birthweight discrepancy has been identified as a risk factor for perinatal morbidity and mortality in twin pregnancies. However, it remains unclear whether such discordance can be predicted by various biological indices with specific cut-off values, and how these depend on the gestational age. We aimed to determine the most effective way to predict large birthweight discordance at various gestational ages. MATERIAL AND METHODS A retrospective cohort study of dichorionic twins, live-born between 2008 and 2018, was conducted. Discordances in biparietal diameter, head circumference, humerus and femur length, abdominal circumference, and estimated fetal weight were calculated-([larger twin - smaller twin] / larger twin) × 100%-and compared between those with and without a large birthweight discordance (≥20%). Receiver operating characteristic curves were constructed to analyze the predictive characteristics of each parameter. RESULTS Of 598 dichorionic twin pregnancies included, 83 (13.9%) had a birthweight discordance ≥20%. Group differences in biparietal diameter and head circumference discordance were the earliest to emerge (before 20 weeks of gestation), but became insignificant after 36 weeks, followed by humerus and femur length, estimated fetal weight discordance (after 20 weeks), and abdominal circumference discordance (after 28 weeks). The best predictors (with cut-off values) were discordance in biparietal diameter ≥7.8% at <20 weeks, head circumference ≥4.5% at 20-23+6 weeks, humerus length ≥4.5% at 24-27+6 weeks, and estimated fetal weight discordance (≥11.6% at 28-31+6 weeks, ≥10.5% at 32-35+6 weeks, and ≥15.0% ≥36 weeks), with sensitivity and specificity of 52%-77% and 69%-82%, respectively. CONCLUSIONS Different predictors and cut-off values may be useful for predicting large inter-twin birthweight discordance in dichorionic twins at different gestational ages. It is more accurate to use biparietal diameter and head circumference discordance in the early second trimester, humerus length discordance in the late second trimester, and estimated fetal weight discordance in the third trimester.
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Affiliation(s)
- Ting Lei
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St George's Hospital and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's Hospital, University of London, London, UK
| | - Jie-Ling Feng
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Fang Lin
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fan Zhang
- Department of Biostatistics Unit, Oncology Research Laboratory, the Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Jahanfar S, Ho JJ, Jaafar SH, Abraha I, Noura M, Ross CR, Pammi M. Ultrasound for diagnosis of birth weight discordance in twin pregnancies. Cochrane Database Syst Rev 2021; 3:CD012553. [PMID: 33686672 PMCID: PMC8078490 DOI: 10.1002/14651858.cd012553.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a need to standardize monitoring in obstetric research of twin pregnancies. Identification of birth weight discordance (BWD), defined as a difference in the birth weights of twins, is a well-documented phenomenon in twin pregnancies. Ultrasound for the diagnosis of BWD informs complex decision making including whether to intervene medically (via laser photo coagulation) or deliver the twins to avoid fetal morbidities or even death. The question is, how accurate is this measurement? OBJECTIVES To determine the diagnostic accuracy (sensitivity and specificity) of ultrasound estimated fetal weight discordance (EFWD) of 20% and 25% using different estimated biometric ultrasound measurements compared with the actual BWD as the reference standard in twin pregnancies. SEARCH METHODS The search for this review was performed on 15 March 2019. We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), seven other databases, conference proceedings, reference lists and contacted experts. There were no language or date restrictions applied to the electronic searches, and no methodological filters to maximize sensitivity. SELECTION CRITERIA We selected cohort-type studies with delayed verification that evaluated the accuracy of biometric measurements at ultrasound scanning of twin pregnancies that had been proposed for the diagnosis of estimated BWD, compared to BWD measurements after birth as a reference standard. In addition, we only selected studies that considered twin pregnancies and applied a reference standard for EFWD for the target condition of BWD. DATA COLLECTION AND ANALYSIS We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility, and extracted data to create 2 × 2 tables. Two review authors independently performed quality assessment using the QUADAS-2 tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 39 eligible studies with a median study sample size of 140. In terms of risk of bias, there were many unclear statements regarding patient selection, index test and use of proper reference standard. Twenty-one studies (53%) were of methodological concern due to flow and timing. In terms of applicability, most studies were of low concern. Ultrasound for diagnosis of BWD in twin pregnancies at 20% cut-off Twenty-two studies provided data for a BWD of 20% and the summary estimate of sensitivity was 0.51 (95% CI 0.42 to 0.60), and the summary estimate of specificity was 0.91 (95% CI 0.89 to 0.93) (8005 twin pregnancies; very low-certainty evidence). Ultrasound for diagnosis of BWD in twin pregnancies at 25% cut-off Eighteen studies provided data using a BWD discordance of 25%. The summary estimate of sensitivity was 0.46 (95% CI 0.26 to 0.66), and the summary estimate of specificity was 0.93 (95% CI 0.89 to 0.96) (6471 twin pregnancies; very low-certainty evidence). Subgroup analyses were possible for both BWD of 20% and 25%. The diagnostic accuracy did not differ substantially between estimation by abdominal circumference and femur length but femur length had a trend towards higher sensitivity and specificity. Subgroup analyses were not possible by sex of twins, chorionicity or gestational age due to insufficient data. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that EFWD identified by ultrasound has low sensitivity but good specificity in detecting BWD in twin pregnancies. There is uncertain diagnostic value of EFWD; this review suggests there is insufficient evidence to support this index as the sole measure for clinical decision making to evaluate the prognosis of twins with growth discordance. The diagnostic accuracy of other measures including amniotic fluid index and umbilical artery Doppler resistive indices in combination with ultrasound for clinical intervention requires evaluation. Future well-designed studies could also evaluate the impact of chorionicity, sex and gestational age in the diagnostic accuracy of ultrasound for EFWD.
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Affiliation(s)
- Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Michigan, USA
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Sharifah Halimah Jaafar
- Department of Obstetrics and Gynaecology, Regency Specialist Hospital, Johor Bahru, Malaysia
| | - Iosief Abraha
- Servizio Immunotrasfusionale, Azienda Unita' Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Mohaddesseh Noura
- Department of Midwifery/Nursing, Golestan University of Medical Sciences, Gorgan, Iran
| | - Cassandra R Ross
- School of Health Sciences, Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Gelman M, Wilkof-Segev R, Gawie-Rotman M, Nadir E, Shrim A, Hallak M, Gabbay-Benziv R. Abdominal circumference discordance for prediction of small for gestational age at birth in twin pregnancies. J Matern Fetal Neonatal Med 2020; 35:3573-3578. [PMID: 33043775 DOI: 10.1080/14767058.2020.1832071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether single sonographic abdominal circumference (AC) discordancy estimation can predict small for gestational age (SGA) at birth in twin gestations. METHODS A retrospective analysis of prospectively collected data. Cohort included all twin gestations delivered at one university-affiliated medical center between 2010 and 2018, with available sonographic evaluation from 22 gestational weeks to term. Pregnancies complicated by fetal chromosomal abnormalities, major anomalies or twin to twin transfusion syndrome were excluded. One sonographic evaluation per pregnancy was selected randomly. AC discordance was calculated as (large twin AC - small twin AC)/large twin AC*100. Prediction of SGA at birth for at least one newborn (<10% percentile for gestational age by gender-specific local curves for multiples) was evaluated using ROC statistics with calculation of Youden index to establish best AC discordance cutoff. AC discordance prediction performance was compared to estimated fetal weight discordance performance. Results were adjusted for confounders using logistic regression analysis. RESULTS After exclusion, 236 twin gestations entered analysis. Of them, 200/236 (84.7%) were dichorionic-diamniotic twins. Mean gestational age at ultrasound evaluation and at delivery were 30.9 ± 4.4 and 35.9 ± 2.4 weeks, respectively. In 28/236 (11.8%) pregnancies, at least one neonate was born SGA. AC discordance predicted SGA at birth as good as sonographic estimated fetal weight (sEFW) discordance: ROC-AUC 0.76, 95% CI 0.67-0.85 vs. 0.77 95% CI 0.66-0.87, p < .001 for all. Best AC discordance cutoff for prediction of SGA at birth was 7.1% (57% sensitivity, 87% specificity), ROC-AUC 0.72 (95% CI 0.61-0.84, p < .001). Results remained significant after adjustment for maternal age, nulliparity, chorionicity and ultrasound to delivery interval (aOR 1.21 95% CI 1.1-1.32, p < .001). CONCLUSION According to our results, AC discordance at single sonographic evaluation can predict SGA at birth in twin gestations as good as sEFW discordance. Best cutoff for SGA prediction was 7.1%.
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Affiliation(s)
- Milana Gelman
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Renana Wilkof-Segev
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Moran Gawie-Rotman
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Erez Nadir
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel.,Department of Newborn and Neonatal Care, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Alon Shrim
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mordechai Hallak
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, The Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Hadera, Israel
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Yuan T, Li C, Wang YY, Wang W, Li XL, Li F, Han Z. Predictive value of prenatal ultrasound parameters for dichorionic growth discordant twins. BMC Pregnancy Childbirth 2020; 20:433. [PMID: 32727413 PMCID: PMC7388498 DOI: 10.1186/s12884-020-03079-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Twin growth discordance was demonstrated to be a risk factor for adverse perinatal outcomes, and prenatal ultrasonographic methods were utilized to predict twin growth discordance to improve outcomes. The results currently reported are not consistent due to the poor unified parameters and gestational durations. METHODS A total of 71 dichorionic twins with growth discordance and 346 dichorionic twins with normal growth were respectively included in the retrospective cohort study. The weight discordance of more than 25% was defined as a "growth discordant twin". The clinical baseline information, maternal outcomes, twin birth weights and fetal growth parameters (which were measured by ultrasound) were compared between the two groups from early gestation to late gestation. Multiple logistic regression and receiver operating characteristic curves were adopted to evaluate the predictive value of the growth parameters. RESULTS Compared with normal dichorionic twins, the clinical baseline conditions were similar in the twins those finally developed growth discordance. The fetal growth parameters and the deepest volume pocket of amniotic fluid in early and mid-pregnancy showed no obvious predictive values. The fetal growth parameters in late pregnancy showed predictive values, especially the discordance of estimated fetal weight (EFW) in the early third-trimester (P < 0.001, area under the curve, 0.822; the cut-off value, 20%; sensitivity, 66.67%; specificity, 91.30%; positive predictive value, 88.46%). CONCLUSION Two assessment approaches were suggested and adopted to predict twin growth discordance in the current study. Twin growth should be assessed longitudinally and dynamically. Normal twins may show growth imbalance in the early stage. The discordance of EFW in late pregnancy may be a useful indicator for a growth discordance of more than 25%, which is required further confirmation.
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Affiliation(s)
- Ting Yuan
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Chao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yan Yan Wang
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Wei Wang
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xue Lan Li
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Fen Li
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Zhen Han
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China.
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9
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Di Mascio D, Acharya G, Khalil A, Odibo A, Prefumo F, Liberati M, Buca D, Manzoli L, Flacco ME, Brunelli R, Benedetti Panici P, D'Antonio F. Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis. Acta Obstet Gynecol Scand 2019; 98:1245-1257. [DOI: 10.1111/aogs.13613] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Daniele Di Mascio
- Department of Gynecological‐Obstetrical and Urological Sciences Sapienza University of Rome Rome Italy
| | - Ganesh Acharya
- Department of Clinical Science, Intervention and Technology Karolinska Institute Stockholm Sweden
- Women's Health and Perinatology Research Group Department of Clinical Medicine Faculty of Health Sciences UiT – The Arctic University of Norway Tromsø Norway
| | - Asma Khalil
- Fetal Medicine Unit St George's Hospital London UK
| | - Anthony Odibo
- Division of Maternal‐Fetal Medicine Department of Obstetrics and Gynecology University of South FloridaMorsani College of Medicine Tampa Florida USA
| | - Federico Prefumo
- Department of Obstetrics and Gynecology University of Brescia Brescia Italy
| | - Marco Liberati
- Department of Obstetrics and Gynecology University of Chieti Chieti Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology University of Chieti Chieti Italy
| | - Lamberto Manzoli
- Department of Medical Sciences University of Ferrara Ferrara Italy
| | | | - Roberto Brunelli
- Department of Gynecological‐Obstetrical and Urological Sciences Sapienza University of Rome Rome Italy
| | | | - Francesco D'Antonio
- Women's Health and Perinatology Research Group Department of Clinical Medicine Faculty of Health Sciences UiT – The Arctic University of Norway Tromsø Norway
- Department of Obstetrics and Gynecology University Hospital of Northern Norway Tromsø Norway
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10
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Poulsen SS, Sinding M, Hansen DN, Peters DA, Frøkjær JB, Sørensen A. Placental T2* estimated by magnetic resonance imaging and fetal weight estimated by ultrasound in the prediction of birthweight differences in dichorionic twin pairs. Placenta 2019; 78:18-22. [PMID: 30955706 DOI: 10.1016/j.placenta.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intertwin birthweight (BW) difference is associated with an increased risk of adverse outcome. Ultrasound estimated fetal weight (EFW) is the current method to predict intertwin BW difference, however, the sensitivity is poor. Therefore, new methods are needed. Placental T2* estimated by magnetic resonance imaging (MRI) provides non-invasive information about the placental function. This study aimed to investigate placental T2* difference as a new predictor of BW difference, and to compare it to the EFW. METHODS We included 25 dichorionic twin pairs at 19-38 weeks' gestation. Placental T2* was obtained by MRI and EFW by ultrasound. Correlations between each predictor and BW difference were examined by simple linear regression, and the combined model was analyzed by multiple linear regression and likelihood ratio test. RESULTS Strong positive correlations were demonstrated between intertwin differences in placental T2* and BW (r = 0.80, p < 0.005), and EFW and BW (r = 0.64, p < 0.005). Placental T2* difference was a strong independent predictor of BW difference (p < 0.001), and the combined model performed better than each predictor alone (p < 0.0001). DISCUSSION This pilot study demonstrates that placental T2* difference may be a predictor of intertwin BW difference irrespectively of fetal size. The clinical potential of this method deserves further investigation in a larger clinical study.
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Affiliation(s)
- Sofie Sondrup Poulsen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark
| | - Marianne Sinding
- Department of Obstetrics and Gynecology, Viborg Regional Hospital, Heibergs Alle 4, 8800, Viborg, Denmark.
| | - Ditte Nymark Hansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - David A Peters
- Department of Clinical Engineering, Central Denmark Region, Olof Palmes Alle 13, 8200, Aarhus N, Denmark
| | - Jens B Frøkjær
- Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Anne Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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11
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The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes. Arch Gynecol Obstet 2018; 299:459-468. [PMID: 30564927 DOI: 10.1007/s00404-018-5002-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the value of ultrasound approaching delivery to predict isolated inter-twin discordance and adverse perinatal outcomes. METHODS We retrospectively included twin pregnancies with sonography approaching delivery in ten maternal-foetal medicine centres in China from 2013 to 2014. Estimated foetal weight (EFW) and inter-twin EFW disparity (EFWD) were calculated based on biometry parameters. Percentage errors between EFW and actual birthweight or between EFWD and actual inter-twin disparity were calculated. ROC curves and multiple logistic regression were applied to evaluate the ability of EFWD to predict inter-twin disparity ≥ 25%, stillbirth, asphyxia and admission to a neonatal intensive unit (NICU). Chorionicity-stratified analysis was further performed. RESULTS Two hundred sixty-six monochorionic and 760 dichorionic twin pregnancies were analysed. The percentage errors in foetal weight estimations were 7-13%, whereas percentage errors in the estimation of inter-twin disparity were nearly 100%. Among eight formulas, Hadlock1 performed best, with a detectable rate of 65% and a false positive rate of 5% when predicting inter-twin disparity ≥ 25%. EFWD ≥ 22% was strongly associated with stillbirth (OR = 4.17, 95% CI 1.40-12.40) and NICU admission (OR = 3.48, 95% CI 2.03-5.97) after adjustment for gestational age, parity and abnormal umbilical systolic/diastolic ratio. Ultrasound had better predictive ability in monochorionic twins. CONCLUSION The predictive value of ultrasound for isolated inter-twin discordance and adverse perinatal outcomes was limited, which was possibly due to the magnifying of systematic errors in the disparity estimation compared with weight estimation. Despite this, abnormal biometry was an independent contributor for the poor prognosis of neonates.
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12
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Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev 2018; 39:851-894. [PMID: 29982551 DOI: 10.1210/er.2018-00083] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
Children born small for gestational age (SGA), defined as a birth weight and/or length below -2 SD score (SDS), comprise a heterogeneous group. The causes of SGA are multifactorial and include maternal lifestyle and obstetric factors, placental dysfunction, and numerous fetal (epi)genetic abnormalities. Short-term consequences of SGA include increased risks of hypothermia, polycythemia, and hypoglycemia. Although most SGA infants show catch-up growth by 2 years of age, ∼10% remain short. Short children born SGA are amenable to GH treatment, which increases their adult height by on average 1.25 SD. Add-on treatment with a gonadotropin-releasing hormone agonist may be considered in early pubertal children with an expected adult height below -2.5 SDS. A small birth size increases the risk of later neurodevelopmental problems and cardiometabolic diseases. GH treatment does not pose an additional risk.
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Affiliation(s)
- Martijn J J Finken
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Carolina C J Smeets
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Marie J E Walenkamp
- Department of Pediatrics, VU University Medical Center, MB Amsterdam, Netherlands
| | - Christiaan de Bruin
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
| | - Anita C S Hokken-Koelega
- Department of Pediatrics, Erasmus University Medical Center/Sophia Children's Hospital, CN Rotterdam, Netherlands
| | - Jan M Wit
- Department of Pediatrics, Leiden University Medical Center, RC Leiden, Netherlands
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13
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Neves AR, Nunes F, Branco M, Almeida MDC, Santos Silva I. The role of ultrasound in the prediction of birth weight discordance in twin pregnancies: are we there yet? J Perinat Med 2018; 46:163-168. [PMID: 28755531 DOI: 10.1515/jpm-2016-0371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the accuracy of ultrasound prediction of birth weight discordance (BWD) and the influence of chorionicity and fetal growth restriction (FGR) on ultrasound performance. METHODS Retrospective analysis of 176 twin pregnancies at a Portuguese tertiary center, between 2008 and 2014. Last ultrasound biometry was recorded. Cases with delivery before 24 weeks, fetal malformations, interval between last ultrasound and deliver >3 weeks, twin-to-twin transfusion syndrome and monoamniotic pregnancies were excluded. The accuracy of prediction of BWD was assessed using the area under the receiver-operating characteristics curve (AUC). RESULTS BWD ≥20% was present in 21.6% of twin pregnancies. EBW had the best predictive performance for BWD (AUC 0.838, 95%CI 0.760-0.916), with a negative predictive value of 86.9% and a positive predictive value of 51.3%. Chorionicity did not influence ultrasound performance. None of the biometric variables analyzed was predictive of BWD in pregnancies without FGR. CONCLUSION The accuracy of ultrasound in the prediction of BWD is limited, particularly in pregnancies without fetal growth restriction. Clinical decisions should not rely on BWD alone.
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Affiliation(s)
- Ana Raquel Neves
- Department of Obstetrics B, Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 17, 3000-045, Coimbra, Portugal, Tel.: +351239400400
| | - Filipa Nunes
- Department of Obstetrics B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Branco
- Department of Obstetrics B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria do Céu Almeida
- Department of Obstetrics B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Santos Silva
- Department of Obstetrics B, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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14
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Laventhal NT, Treadwell MC. Ethical considerations in the care of complicated twin pregnancies. Semin Fetal Neonatal Med 2018; 23:7-12. [PMID: 29103877 DOI: 10.1016/j.siny.2017.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Twin gestations are increasing in prevalence worldwide, and are potentially subject to medical complications which present uniquely complex ethical and psychosocial challenges for the pregnant patient and obstetrician to navigate. In this article, we explore these issues as they relate to medical decision-making in cases of discordant growth and discordant anomalies in both monochorionic and dichorionic twin pregnancies, including those affected by twin-twin transfusion syndrome, with particular attention to scenarios in which the individual fetuses hold competing interests. For each of these scenarios, we consider how decisions may positively or negatively impact one or both fetuses, and how familiarity with population outcomes, as well as sensitivity to the complex psychosocial circumstances surrounding these pregnancies, can support and inform shared decision-making.
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15
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Leombroni M, Liberati M, Fanfani F, Pagani G, Familiari A, Buca D, Manzoli L, Scambia G, Rizzo G, D'Antonio F. Diagnostic accuracy of ultrasound in predicting birth-weight discordance in twin pregnancy: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:442-450. [PMID: 27804184 DOI: 10.1002/uog.17348] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of ultrasound in predicting birth-weight (BW) discordance in twin pregnancy. METHODS Electronic databases PubMed, EMBASE and CINAHL were searched using combinations of MeSH terms 'birth weight', 'discordance', 'twins' and 'ultrasound'. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios for the predictive accuracy of sonographically estimated fetal-weight (EFW) discordance and abdominal-circumference (AC) discordance in predicting BW discordance were computed using hierarchical summary receiver-operating characteristics curves. RESULTS Twenty studies (including 5826 twin pregnancies) were included. EFW discordance ≥ 20% had a sensitivity of 65.4% and specificity of 90.8% in predicting BW discordance ≥ 20%. The predictive performance of ultrasound performed within 1 month, 2 weeks and 3 days before birth was 61.4%, 72.3% and 78.9%, respectively. EFW discordance ≥ 25% had a sensitivity of 57.7% and specificity of 95.2% in predicting BW discordance ≥ 25%. The sensitivity of EFW discordance ≥ 25% detected within 1 month, 2 weeks and 3 days before birth was 60.0%, 75.0% and 60.3%, respectively, while the corresponding values for specificity were 97.7%, 96.2% and 87.3%, respectively. In view of the different cut-offs reported among studies, it was not possible to perform comprehensive data synthesis for each AC discordance cut-off. The optimal diagnostic performance of AC discordance was for prediction of BW discordance ≥ 25%, with a sensitivity of 70.8% and specificity of 86.4%. CONCLUSION Ultrasound EFW discordance has an overall moderate accuracy in predicting BW discordance in twin pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Leombroni
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - M Liberati
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - F Fanfani
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - G Pagani
- Department of Obstetrics and Gynaecology, Fondazione Poliambulanza, Brescia, Italy
| | - A Familiari
- Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - D Buca
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - L Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Scambia
- Department of Maternal-Fetal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - G Rizzo
- Department of Obstetrics and Gynaecology, University of Rome Tor Vergata, Rome, Italy
| | - F D'Antonio
- Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, and Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
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16
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Queirós A, Blickstein I, Valdoleiros S, Felix N, Cohen A, Simões T. Prediction of birth weight discordance from fetal weight estimations at 21-24 weeks' scans in monochorionic and dichorionic twins. J Matern Fetal Neonatal Med 2017; 30:1944-1947. [PMID: 27596564 DOI: 10.1080/14767058.2016.1233397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate if inter-twin estimated fetal weight (EFW) differences at 21-24 weeks' scans predict birth weight discordance in monochorionic and dichorionic twins born at three gestational age periods. METHODS We counted the number of pairs with discordant EFWs (EFWs greater than the mean + 1SD; i.e. a difference above 12% in dichorionic and 21% in monochorionic twins) derived during a 21-24 weeks' scan as compared to actual discordant birth weight (>25%) in monochorionic and dichorionic pairs born at ≤32, 33-36 and >36 weeks. RESULTS We studied 416 dichorionic and 244 monochorionic twins. The frequency of EFWs discordance at 21-24 weeks was the same for dichorionic and monochorionic twins but the total number of birth weight discordant pairs was significantly smaller among dichorionic twins (OR 0.2, 95% CI 0.1, 0.6). Generally, the positive predictive values for birth weight discordance by using the EFWs difference were quite poor, but always better in monochorionic than in dichorionic twins. Whereas the negative predictive value and hence the sensitivity for monochorionic twins was 100% irrespective of gestational age at birth, it was much lower in the dichorionic pairs. CONCLUSION Concordant EFWs at 21-24 weeks exclude discordant birth weight in monochorionic twins whereas discordant EFWs are poor predictors of birth weight discordance especially in dichorionic twins irrespective when the twins were born.
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Affiliation(s)
- Alexandra Queirós
- a Department of Maternal-Fetal Medicine Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa , Lisbon , Portugal
| | - Isaac Blickstein
- b Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and the Hadassah-Hebrew University School of Medicine , Jerusalem , Israel
| | - Sandra Valdoleiros
- a Department of Maternal-Fetal Medicine Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa , Lisbon , Portugal
| | - Nisa Felix
- a Department of Maternal-Fetal Medicine Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa , Lisbon , Portugal
| | - Alvaro Cohen
- a Department of Maternal-Fetal Medicine Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa , Lisbon , Portugal
| | - Teresinha Simões
- a Department of Maternal-Fetal Medicine Maternity Dr. Alfredo da Costa, Centro Hospitalar Lisboa Central and Universidade Nova de Lisboa , Lisbon , Portugal
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