The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes
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To investigate the value of ultrasound approaching delivery to predict isolated inter-twin discordance and adverse perinatal outcomes.
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.
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.
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.
KeywordsInter-twin discordance Ultrasound Estimated fetal weight (EFW) Stillbirth Admission to neonatal intensive care unit
We acknowledge the contributions of the members of the Collaborative Group on Twin Birth and Fetal Abnormality in China (CGTBFA), including the Shengjing Hospital of China Medical University (Prof. Caixia Liu), Women’s Hospital School of Medicine Zhejiang University (Prof. Jing He), the Shanghai First Maternity and Infant Health Institute Affiliated to Tongji University (Prof. Tao Duan), the Third Hospital Affiliated to Guangzhou Medical University (Prof. Dunjin Chen), the Shandong Provincial Hospital to Shandong University(Prof. Xietong Wang), the First Affiliated Hospital of Sun Yat-sen University (Prof. Zilian Wang), the First Affiliated Hospital of Chongqing Medical University (Prof. Hongbo Qi), the Peking University First Hospital (Prof. HuixiaYang) and the Nanjing Drum Tower Hospital of Nanjing Medical University (Prof. Yali Hu).
XC: data collection, data analysis, manuscript writing. QZ: data collection, manuscript editing. XX: data management, manuscript editing. XL: project development, funding acquisition, data management, manuscript editing.
This study was funded by Shanghai Medical Center of Key Programs for Female Reproductive Diseases (2017ZZ01016), National Key Research and Development Program of Reproductive Health & Major Birth Defects Control and Prevention (2016YFC1000403, 2016YFC1000403), and Shanghai Committee of Science and Technology (18411963400).
Compliance with ethical standards
Conflict of interest
We declare that we have no conflict of interest.
This study obtained ethical approval from each institutional ethics committee of 10 collaborative hospitals (Obstetrics and Gynecology Hospital of Fudan University, First Affiliated Hospital of Sun Yat-sen University, First Affiliated Hospital of Chongqing Medical University, Gulou Clinical Medical College of Nanjing Medical University, Peking University First Hospital, Shandong Provincial Hospital of Shandong University, Shanghai First Maternity and Infant Health Institute Affiliated with Tongji University, Shengjing Hospital of China Medical University, Third Hospital Affiliated with GuangZhou Medical University, and Women’s Hospital School of Medicine at Zhejiang University). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.
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