Estimated fetal weight in twin pregnancy: how good are we?

Ultrasound estimation of birth weight in twin pregnancy: comparison of biometry algorithms in the STORK multiple pregnancy cohort

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.

Estimation of fetal weight in twins: a new mathematical model

OBJECTIVES

Evaluation of new mathematical formula (Femur 4) derived from a twin population to estimate fetal weight in twins using ultrasound. Comparison of Femur 4 is with conventional mathematical models.

DESIGN

Retrospective analysis of ultrasonic measurements of 297 twin babies from 24 to 40 weeks of gestation who were born within 10 days of ultrasound examination.

SETTING

Aberdeen Maternity Hospital.

METHODS

With ultrasonic measurements obtained from twin babies, estimated fetal weight was calculated using the mathematical models of Campbell, Shepard and Hadlock. The calculations were repeated for the model of Femur 4. All models were compared against Femur 4.

RESULTS

The coefficient of determination of the linear regression between the actual and predicted weight was highest for Femur 4 (0.852). Femur 4 had the highest proportion of babies with estimated weights within 10% of actual birthweight (71.4%). In babies who weighed between 2000 and 3000 g, Femur 4 had the least systematic and random error of -1.69 and 8.96, respectively. For babies below the 10th centile for weight, Femur 4 had comparable positive and negative predictive values of 76.0% and 92.3%, respectively. Femur 4 was equally poor at predicting growth discordancy with positive and negative predictive values of 70.0% and 86.5% only.

CONCLUSION

Femur 4 requires measurements of femur length and abdominal circumference only, hence avoiding the need to obtain difficult head measurements which is a common problem in twins. It is a good model for estimation of fetal weight in twins. However, prediction of growth discordancy remains problematic.