M Baraa Allaf1, Winston A Campbell1, Anthony M Vintzileos1, Sina Haeri1, Pouya Javadian1, Amir A Shamshirsaz1, Paul Ogburn1, Reinaldo Figueroa1, Joseph Wax1, Glenn Markenson1, Martin R Chavez1, Samadh F Ravangard1, Rodrigo Ruano1, Haleh Sangi-Haghpeykar1, Bahram Salmanian1, Marjorie Meyer1, Jeffery Johnson1, Ali Ozhand1, Sarah Davis1, Adam Borgida1, Michael A Belfort1, Alireza A Shamshirsaz2. 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.
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.
Authors: Urszula Nowacka; Katarzyna Kosińska-Kaczyńska; Paweł Krajewski; Aleksandra Saletra-Bielińska; Izabela Walasik; Iwona Szymusik Journal: Int J Environ Res Public Health Date: 2021-02-19 Impact factor: 3.390