Format

Send to

Choose Destination
J Ultrasound Med. 2014 Sep;33(9):1573-8. doi: 10.7863/ultra.33.9.1573.

Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?

Author information

1
Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.).
2
Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.). aashamsh@texaschildrens.org shamshir@bcm.edu.

Abstract

OBJECTIVES:

To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.

METHODS:

We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven early-onset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed.

RESULTS:

Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes.

CONCLUSIONS:

In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.

KEYWORDS:

monochorionic twins; nuchal translucency; obstetric ultrasound; second trimester; twin-twin transfusion syndrome

PMID:
25154937
DOI:
10.7863/ultra.33.9.1573
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center