Amniotic fluid phospholipid profile in multiple pregnancy and the effect of zygosity

Concordance of the risk of neonatal respiratory morbidity assessed by quantitative ultrasound lung texture analysis in fetuses of twin pregnancies

To evaluate the concordance of the risk of neonatal respiratory morbidity (NRM) assessed by quantitative ultrasound lung texture analysis (QuantusFLM) between twin fetuses of the same pregnancy. Prospective study conducted in twin pregnancies. Fetal ultrasound lung images were obtained at 26.0–38.6 weeks of gestation. Categorical (high or low) and continuous results of the risk of NRM were compared between twins. Fetal ultrasound lung images from 131 pairs (262 images) of twins were included. The images were classified into three gestational age ranges: Group 1 (26.0–29.6 weeks, 78 images, 39 pairs [29.8%]); Group 2 (30.0–33.6 weeks, 98 images, 49 pairs [37.4%]) and Group 3 (34.0–38.6 weeks, 86 images, 43 pairs [32.8%]). Concordance was good in Groups 1 and 3 and moderate in Group 2. In Groups 2 and 3 at least one fetus presented high-risk results in 26.5% and 11.6% of twin pairs, respectively. Only gestational age < 32 weeks, gestational diabetes mellitus, and spontaneous conception were associated with a high risk of NRM in Group 2. There was good concordance of the risk of NRM between twins < 30.0 weeks and > 34.0 weeks. From 30.0 to 33.6 weeks 26.5% of the twin pairs had discordant results, with moderate concordance of the risk of NRM.

Neonatal functional lung maturity relative to gestational age at delivery, fetal growth, and pregnancy characteristics in triplet births

OBJECTIVE

The purpose of this study was to determine if functional lung maturity (FtLM) of triplets was affected by differentiating factors within the triplet set.

METHODS

This was a retrospective cohort study of triplets. Data were collected on maternal, pregnancy and neonatal characteristics and FtLM was determined, based on selected neonatal outcomes.

RESULTS

Functional lung immaturity (FtLI) was found in 35.5% of the infants and occurred in those born between 28.1 and 34.6 weeks gestation. Gestational age at delivery, pre-pregnancy BMI, and gestational diabetes were predictive of an infant having FtLM; while infertility treatment, pre-pregnancy BMI, and preeclampsia were predictors of FtLM discordance.

CONCLUSIONS

Our results demonstrated FtLI was likely at early gestation (<28 weeks) and FtLM was probable beyond 35 weeks. Discordance for FtLM was likely at 32 weeks; therefore, clinicians should guard against complacency that this gestational mark assures an uncomplicated respiratory course for all infants within the set.

Predicting concordance of biochemical lung maturity in the preterm twin gestation

OBJECTIVE

To propose a strategy for lung maturity amniocentesis in diamnionic twin gestations by exploiting indicators of concordance of lung maturity status.

METHODS

Amniotic fluid from 92 diamnionic twin gestations was assayed for lung maturity by standard methodology. The rates of concordance of lung maturity status between twins were calculated after stratification by gestational age, chorionicity, gender and weight discordance.

RESULTS

At the extremes of gestational age (28, 29, 36 and 37 weeks), twins are 100% concordant in lung status; for twins of 33-35.9 gestational weeks, lung concordance is significantly lower at 0.91 (p = 0.02); for 30-32.9 weeks, a rate of 0.52 is even lower (p = 0.001). Same-gender twin pairs of 33-35.9 weeks and twin pairs with estimated fetal weight discordance exceeding 20% or less than 10% were uniformly concordant in their lung maturity.

CONCLUSION

Non-selective single amniocentesis may be performed if the gestational age is greater than 35.9 weeks. Double amniocentesis should be performed in the following: twins of 30-32.9 gestational weeks and twins of 33-35.9 weeks unless the twin pair is gender-concordant, or calculated fetal weight discordance is less than 10% or greater than 20%.