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Barati M, Najafian M, Saadati N, Motefares M. Investigation of the Association of Abdominal Circumference Discord-ance and Estimated Fetal Weight Discordance in Twins with Birth Weight Discordance. Med J Islam Repub Iran 2024; 38:30. [PMID: 38803389 PMCID: PMC11129283 DOI: 10.47176/mjiri.38.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Indexed: 05/29/2024] Open
Abstract
Background Twin pregnancy is associated with a high risk of mortality and morbidity. It is necessary to estimate the weight difference of the fetuses with a reliable method to prevent possible complications. This study was conducted to compare the association between the Estimated fetal weight (EFW) discord-ance and the Abdominal Circumference (AC) discordance with birth weight in twins. Methods This was a descriptive-analytical and retrospective study. The statistical population was all twin pregnant mothers referred to Imam Khomeini Hospital in Ahvaz from 2017 to 2019. The sample size was determined with a census (540 people). Based on AC , the size of head circumference (HC), femur length (FL), and the Biparietal Diameter (BPD), EFW was calculated. Then the EFW Dis-cordance and AC Discordance were calculated and compared with the birth weight. Data were analyzed using SPSS18. Unpaired, Two-Tailed T-test and Pearson correlation test were used. Results The results showed that the mean discordance of fetal weight in twin pregnancies in the EFW method was 9.25%, in the AC method was 9.89% and finally, at birth, was 10.72%. The correla-tion of the weight difference between the two embryos in the AC method with the time of birth (r = 0.922 and P < 0.001) was higher than in the EFW method with the time of birth (r = 0.69 and P < 0.001) and finally, it was found that in detecting the discordance more than 20% and 25%, AC diagnostic power was good, but EFW was moderate. Conclusion Therefore, to evaluate the weight and weight difference in twin embryos, the AC method has the appropriate accuracy and compatibility. Another major prospective study to evaluate the diagnostic performance of AC and EFW mismatch based on gestational age at scan, incision point, and maternal and placental characteristics to determine true ultrasound diagnostic accuracy in predict-ing growth mismatch in twin pregnancy and optimal post-case management option is needed.
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Affiliation(s)
- Mojgan Barati
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmieh Saadati
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Motefares
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Rosen H, Gold-Zamir Y, Lopian M, Weissbach T, Kassif E, Weisz B. Accuracy of sonographic fetal weight estimation and prediction of birth-weight discordance in twin pregnancy: large single-center study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:821-828. [PMID: 37265171 DOI: 10.1002/uog.26277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the accuracy of sonographic fetal weight estimation in predicting birth weight (BW) and BW discordance in twin gestations, and to evaluate maternal and fetal characteristics that may affect the accuracy of this assessment. METHODS This was a retrospective cohort study of all twins delivered at a single tertiary medical center between 2010 and 2021. Twin gestations for which sonographic estimation of fetal weight was performed within the week preceding delivery were included. Statistical analysis was performed to evaluate the strength of the correlation between sonographic estimated fetal weight (EFW) and BW, and to determine the impact of maternal and fetal factors on the accuracy of sonographic estimation. RESULTS The study included 2154 twin pregnancies. There was a strong correlation between sonographic EFW and corresponding BW for all twins (r = 0.922; P < 0.001). Strong correlations were observed for both the presenting and non-presenting cotwin (r = 0.921 and r = 0.922, respectively; both P < 0.001), as well as the larger and smaller cotwin (r = 0.928 and r = 0.934, respectively; both P < 0.001). The overall mean ± SD absolute error of sonographic EFW was 7.41 ± 6.81%. This error was greater for the non-presenting cotwin compared with the presenting cotwin (7.99 ± 6.12% vs 7.17 ± 5.64%; P < 0.001), and for the smaller cotwin compared with the larger cotwin (8.56 ± 7.50% vs 6.58 ± 5.47%; P < 0.001). Advanced gestational age at scanning was correlated inversely with the mean absolute error of sonographic EFW. Multivariate logistic regression indicated that an earlier gestational age at scanning, being the non-presenting cotwin and being the smaller cotwin were independent risk factors for sonographic EFW inaccuracy. Pregnancies in which the presenting twin was estimated to be the smaller cotwin had twice the rate of false-positive BW discordance compared with pregnancies in which the presenting twin was estimated to be the larger cotwin (36.0% vs 13.0% for BW discordance > 15%, 35.0% vs 17.0% for BW discordance > 20% and 37.7% vs 12.1% for BW discordance > 25%; all P < 0.001). The error in sonographic EFW discordance was not related to chorionicity, the position of the presenting fetus or gestational age at the time of fetal weight estimation. CONCLUSIONS Sonographic estimation of fetal weight within 7 days before delivery accurately predicts BW in twin pregnancy. Sonographic EFW accuracy is reduced for the non-presenting twin, the smaller cotwin and when delivery occurs at an earlier gestational age. Sonographic estimation of fetal weight discordance is less accurate when the presenting twin is the smaller cotwin. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H Rosen
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Gold-Zamir
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - M Lopian
- Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - T Weissbach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - E Kassif
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - B Weisz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
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Ye S, Fan D, Li P, Chen G, Rao J, Zhang H, Zhou Z, Feng J, Luo C, Guo X, Liu Z, Lin D. Assessment of different thresholds of birthweight discordance for early neonatal outcomes: retrospective analysis of 2348 twin pregnancies. BMC Pregnancy Childbirth 2022; 22:93. [PMID: 35105310 PMCID: PMC8808974 DOI: 10.1186/s12884-022-04417-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background The optimal threshold of birthweight discordance (BWD) remains controversial. This study aimed to evaluate the associations between BWD at different thresholds and early neonatal outcomes and to assess their predictive accuracy. Methods This was a retrospective cohort study using a birthweight data with the chorionicity information of 2348 liveborn twin pairs at a gestational age of ≥26 weeks, from 2012 to 2018. The percentage of BWD was calculated by dividing the actual birthweight difference by the weight of the larger twin and multiplying by 100. Outcomes of interest included neonatal intensive care unit (NICU) admission, neonatal respiratory distress syndrome (NRDS), ventilator support and a composite outcome combining major morbidities and neonatal death. Logistic regression models were performed to estimate the association between neonatal outcomes and BWD with different thresholds (≥15.0%, ≥20.0%, ≥25% and ≥ 30%). Generalized estimated equation (GEE) models were used to address intertwin correlation. Restrictive cubic spline (RCS) models were established to draw the dose-response relationship between BWD and the odds ratios of outcomes. Clustered receiver operating characteristic (ROC) curve analyses were performed to assess the predictive accuracy. Results Of 2348 twin pairs, including 1946 dichorionic twin pairs and 402 monochorionic twin pairs, BWD was significantly associated with NICU admission, regardless of the thresholds used. The incidence of NRDS, ventilator support and the composite outcome were significantly higher when a threshold of ≥20% or greater was chosen. The dose-response relationship showed nonlinear growth in the risk of adverse neonatal outcomes with increasing BWD. ROC analyses showed a low significant AUROC of 0.569 (95% CI: 0.526–0.612) for predicting NICU admission but no significant AUROCs for predicting other outcomes. A BWD of ≥30% provided a moderate increase in the likelihood of NICU admission [positive likelihood ratio (LR+) = 5.77]. Conclusion Although BWD is independently associated with adverse neonatal outcomes, it is not a single predictor for neonatal outcomes given the weak discriminative ability to predict neonatal outcomes. A cutoff of 30% is more practical for risk stratification among twin gestations. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04417-4.
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Affiliation(s)
- Shaoxin Ye
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Pengsheng Li
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Jiaming Rao
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Huishan Zhang
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zixing Zhou
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Jinping Feng
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Caihong Luo
- Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China.,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
| | - Dongxin Lin
- Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, 11 Renminxi Road, Foshan, 528000, Guangdong, China. .,Department of Obstetrics, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, 528000, Guangdong, China.
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Lei T, Zheng J, Papageorghiou AT, Feng JL, Lin MF, Zhang F, Xie HN. Ultrasound in the prediction of birthweight discordance in dichorionic twins. Acta Obstet Gynecol Scand 2021; 100:908-916. [PMID: 33253418 DOI: 10.1111/aogs.14055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Large birthweight discrepancy has been identified as a risk factor for perinatal morbidity and mortality in twin pregnancies. However, it remains unclear whether such discordance can be predicted by various biological indices with specific cut-off values, and how these depend on the gestational age. We aimed to determine the most effective way to predict large birthweight discordance at various gestational ages. MATERIAL AND METHODS A retrospective cohort study of dichorionic twins, live-born between 2008 and 2018, was conducted. Discordances in biparietal diameter, head circumference, humerus and femur length, abdominal circumference, and estimated fetal weight were calculated-([larger twin - smaller twin] / larger twin) × 100%-and compared between those with and without a large birthweight discordance (≥20%). Receiver operating characteristic curves were constructed to analyze the predictive characteristics of each parameter. RESULTS Of 598 dichorionic twin pregnancies included, 83 (13.9%) had a birthweight discordance ≥20%. Group differences in biparietal diameter and head circumference discordance were the earliest to emerge (before 20 weeks of gestation), but became insignificant after 36 weeks, followed by humerus and femur length, estimated fetal weight discordance (after 20 weeks), and abdominal circumference discordance (after 28 weeks). The best predictors (with cut-off values) were discordance in biparietal diameter ≥7.8% at <20 weeks, head circumference ≥4.5% at 20-23+6 weeks, humerus length ≥4.5% at 24-27+6 weeks, and estimated fetal weight discordance (≥11.6% at 28-31+6 weeks, ≥10.5% at 32-35+6 weeks, and ≥15.0% ≥36 weeks), with sensitivity and specificity of 52%-77% and 69%-82%, respectively. CONCLUSIONS Different predictors and cut-off values may be useful for predicting large inter-twin birthweight discordance in dichorionic twins at different gestational ages. It is more accurate to use biparietal diameter and head circumference discordance in the early second trimester, humerus length discordance in the late second trimester, and estimated fetal weight discordance in the third trimester.
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Affiliation(s)
- Ting Lei
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St George's Hospital and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's Hospital, University of London, London, UK
| | - Jie-Ling Feng
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Fang Lin
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fan Zhang
- Department of Biostatistics Unit, Oncology Research Laboratory, the Cancer Hospital of Shantou University Medical College, Guangdong, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Jahanfar S, Ho JJ, Jaafar SH, Abraha I, Noura M, Ross CR, Pammi M. Ultrasound for diagnosis of birth weight discordance in twin pregnancies. Cochrane Database Syst Rev 2021; 3:CD012553. [PMID: 33686672 PMCID: PMC8078490 DOI: 10.1002/14651858.cd012553.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a need to standardize monitoring in obstetric research of twin pregnancies. Identification of birth weight discordance (BWD), defined as a difference in the birth weights of twins, is a well-documented phenomenon in twin pregnancies. Ultrasound for the diagnosis of BWD informs complex decision making including whether to intervene medically (via laser photo coagulation) or deliver the twins to avoid fetal morbidities or even death. The question is, how accurate is this measurement? OBJECTIVES To determine the diagnostic accuracy (sensitivity and specificity) of ultrasound estimated fetal weight discordance (EFWD) of 20% and 25% using different estimated biometric ultrasound measurements compared with the actual BWD as the reference standard in twin pregnancies. SEARCH METHODS The search for this review was performed on 15 March 2019. We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), seven other databases, conference proceedings, reference lists and contacted experts. There were no language or date restrictions applied to the electronic searches, and no methodological filters to maximize sensitivity. SELECTION CRITERIA We selected cohort-type studies with delayed verification that evaluated the accuracy of biometric measurements at ultrasound scanning of twin pregnancies that had been proposed for the diagnosis of estimated BWD, compared to BWD measurements after birth as a reference standard. In addition, we only selected studies that considered twin pregnancies and applied a reference standard for EFWD for the target condition of BWD. DATA COLLECTION AND ANALYSIS We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility, and extracted data to create 2 × 2 tables. Two review authors independently performed quality assessment using the QUADAS-2 tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 39 eligible studies with a median study sample size of 140. In terms of risk of bias, there were many unclear statements regarding patient selection, index test and use of proper reference standard. Twenty-one studies (53%) were of methodological concern due to flow and timing. In terms of applicability, most studies were of low concern. Ultrasound for diagnosis of BWD in twin pregnancies at 20% cut-off Twenty-two studies provided data for a BWD of 20% and the summary estimate of sensitivity was 0.51 (95% CI 0.42 to 0.60), and the summary estimate of specificity was 0.91 (95% CI 0.89 to 0.93) (8005 twin pregnancies; very low-certainty evidence). Ultrasound for diagnosis of BWD in twin pregnancies at 25% cut-off Eighteen studies provided data using a BWD discordance of 25%. The summary estimate of sensitivity was 0.46 (95% CI 0.26 to 0.66), and the summary estimate of specificity was 0.93 (95% CI 0.89 to 0.96) (6471 twin pregnancies; very low-certainty evidence). Subgroup analyses were possible for both BWD of 20% and 25%. The diagnostic accuracy did not differ substantially between estimation by abdominal circumference and femur length but femur length had a trend towards higher sensitivity and specificity. Subgroup analyses were not possible by sex of twins, chorionicity or gestational age due to insufficient data. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that EFWD identified by ultrasound has low sensitivity but good specificity in detecting BWD in twin pregnancies. There is uncertain diagnostic value of EFWD; this review suggests there is insufficient evidence to support this index as the sole measure for clinical decision making to evaluate the prognosis of twins with growth discordance. The diagnostic accuracy of other measures including amniotic fluid index and umbilical artery Doppler resistive indices in combination with ultrasound for clinical intervention requires evaluation. Future well-designed studies could also evaluate the impact of chorionicity, sex and gestational age in the diagnostic accuracy of ultrasound for EFWD.
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Affiliation(s)
- Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Michigan, USA
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Malaysia
| | - Sharifah Halimah Jaafar
- Department of Obstetrics and Gynaecology, Regency Specialist Hospital, Johor Bahru, Malaysia
| | - Iosief Abraha
- Servizio Immunotrasfusionale, Azienda Unita' Sanitaria Locale Umbria 2, Foligno (PG), Italy
| | - Mohaddesseh Noura
- Department of Midwifery/Nursing, Golestan University of Medical Sciences, Gorgan, Iran
| | - Cassandra R Ross
- School of Health Sciences, Central Michigan University, Mt. Pleasant, Michigan, USA
| | - Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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D'Antonio F, Odibo AO, Prefumo F, Khalil A, Buca D, Flacco ME, Liberati M, Manzoli L, Acharya G. Weight discordance and perinatal mortality in twin pregnancy: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:11-23. [PMID: 29155475 DOI: 10.1002/uog.18966] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/21/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The primary aim of this systematic review was to explore the strength of association between birth-weight (BW) discordance and perinatal mortality in twin pregnancy. The secondary aim was to ascertain the contribution of gestational age and growth restriction in predicting mortality in growth-discordant twins. METHODS MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched. Only studies reporting on the risk of mortality in twin pregnancies affected compared with those not affected by BW discordance were included. The primary outcomes explored were incidence of intrauterine death (IUD), neonatal death (NND) and perinatal death. Outcome was assessed separately for monochorionic (MC) and dichorionic (DC) twin pregnancies. Analyses were stratified according to BW discordance cut-off (≥ 15%, ≥ 20%, ≥ 25% and ≥ 30%) and selected gestational characteristics, including incidence of IUD or NND before and after 34 weeks' gestation, presence of at least one small-for-gestational age (SGA) fetus in the twin pair and both twins being appropriate-for-gestational age. Risk of mortality in the larger vs smaller twin was also assessed. Meta-analyses using individual data random-effects logistic regression and meta-analyses of proportion were used to analyze the data. RESULTS Twenty-two studies (10 877 twin pregnancies) were included in the analysis. In DC pregnancies, a higher risk of IUD, but not of NND, was observed in twins with BW discordance ≥ 15% (odds ratio (OR) 9.8, 95% CI, 3.9-29.4), ≥ 20% (OR 7.0, 95% CI, 4.15-11.8), ≥ 25% (OR 17.4, 95% CI, 8.3-36.7) and ≥ 30% (OR 22.9, 95% CI, 10.2-51.6) compared with those without weight discordance. For each cut-off of BW discordance explored in DC pregnancies, the smaller twin was at higher risk of mortality compared with the larger one. In MC twin pregnancies, excluding cases affected by twin-twin transfusion syndrome, twins with BW discordance ≥ 20% (OR 2.8, 95% CI, 1.3-5.8) or ≥ 25% (OR 3.2, 95% CI, 1.5-6.7) were at higher risk of IUD, compared with controls. MC pregnancies with ≥ 25% weight discordance were also at increased risk of NND (OR 4.66, 95% CI, 1.8-12.4) compared with those with concordant weight. The risk of IUD was higher when considering discordant pregnancies involving at least one SGA fetus. The overall risk of mortality in MC pregnancies was similar between the smaller and larger twin, except in those with BW discordance ≥ 20%. CONCLUSION DC and MC twin pregnancies discordant for fetal growth are at higher risk of IUD but not of NND compared with pregnancies with concordant BW. The risk of IUD in BW-discordant DC and MC twins is higher when at least one fetus is SGA. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
| | - A O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - F Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - A Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - D Buca
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - M E Flacco
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy
| | - M Liberati
- Department of Obstetrics and Gynaecology, University of Chieti, Chieti, Italy
| | - L Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Acharya
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Jahanfar S, Ho JJ, Jaafar SH, Abraha I, Nisenblat V, Ellis UM, Noura M. Ultrasound for diagnosis of birth weight discordance in twin pregnancies. Hippokratia 2017. [DOI: 10.1002/14651858.cd012553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shayesteh Jahanfar
- Central Michigan University; School of Health Sciences; Building 2212 Mount Pleasant Michigan USA 48859
| | - Jacqueline J Ho
- Penang Medical College; Department of Paediatrics; 4 Sepoy Lines Penang Malaysia 10450
| | - Sharifah Halimah Jaafar
- Regency Specialist Hospital; Department of Obstetrics and Gynaecology; No 1 Jalan Suria, Bandar Seri Alam Johor Bahru Johor Malaysia 81750
| | - Iosief Abraha
- Regional Health Authority of Umbria; Health Planning Service; Via Mario Angeloni 61 Perugia PG Italy 06124
| | - Vicki Nisenblat
- The University of Adelaide; Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute; Level 6, Medical School North, Frome Rd Adelaide SA Australia 5005
| | - Ursula M Ellis
- University of British Columbia; Woodward Library; 2198 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - Mohaddesseh Noura
- Golestan University of Medical Sciences; Department of Midwifery/Nursing; Gorgan Golestan Iran 49176 34536
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Jahanfar S, Lim K, Oviedo-Joekes E. Optimal threshold for birth weight discordance: Does knowledge of chorionicity matter? J Perinatol 2016; 36:704-12. [PMID: 27171760 DOI: 10.1038/jp.2016.82] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 02/16/2016] [Accepted: 03/22/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To establish the optimal threshold of birth weight discordance (BWD) for prediction of stillbirth, perinatal mortality and morbidity in twins born in British Columbia with or without chorionicity information. STUDY DESIGN This is a retrospective population-based cohort study of twins born in British Columbia from 2000 to 2010. Data from one hospital was used to adjust for chorionicity. Multivariate generalized estimating equation and receiver operating characteristic curve analyses were performed to evaluate the predictability of BWD in comparison with other fetal anthropometric measurements. Positive likelihood ratio is used to estimate test accuracy. Survival analysis was conducted to take gestational age and other confounders into account. RESULTS We analyzed two cohorts, with (pairs=1493) and without (pairs=6328) chorionicity information, of which 1.5% experienced stillbirth, 2.9% suffered perinatal mortality and 22.6% identified with perinatal morbidities. BWD was a significant predictor of stillbirth. Standard receiver operating characteristic curve analysis and survival analysis suggested that BWD of ⩾30% is the optimal thresholds for stillbirth and perinatal mortality irrespective of chorionicity. However, the P-value for predictive accuracy of BWD was nonsignificant for perinatal morbidity, after adjusting for confounding variables engaging multivariate analysis. Sex discordance can be used as a proxy for chorionicity. CONCLUSION BWD is a good predictor for stillbirth. A BWD cutoff limit of 30% and higher has optimal accuracy for detecting perinatal mortality.
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Affiliation(s)
- S Jahanfar
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - K Lim
- Division of Maternal Fetal Medicine, Vancouver, BC, Canada
| | - E Oviedo-Joekes
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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D'Antonio F, Khalil A, Morlando M, Thilaganathan B. Accuracy of Predicting Fetal Loss in Twin Pregnancies Using Gestational Age-Dependent Weight Discordance Cut-Offs: Analysis of the STORK Multiple Pregnancy Cohort. Fetal Diagn Ther 2015; 38:22-8. [DOI: 10.1159/000369326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
Objectives: A third-trimester fetal weight discordance of 25% has been proposed as an independent predictor of fetal loss in twin pregnancies. As fetal weight gain at this stage of pregnancy increases exponentially, it is not entirely certain whether a single cut-off for inter-twin weight discordance is appropriate. The aim of this study was to investigate whether a single weight discordance cut-off can be used or whether different cut-offs should be adopted according to the gestational age at assessment. Methods: This was a retrospective study of all twin pregnancies of known chorionicity from a large regional cohort over a 10-year period. Receiver operating characteristic curve and logistic regression analyses were used to explore the relation between estimated fetal weight (EFW) discordance detected within 4 weeks from the occurrence of the outcome and single fetal loss at different gestational age windows. Results: 957 twin pregnancies (173 monochorionic and 784 dichorionic) were included in the analysis. EFW discordance was independently associated with the occurrence of single fetal loss in twin pregnancies in each gestational age window. Ultrasound EFW discordance had an area under the curve of 0.77 (95% CI: 0.67-0.87) for the prediction of single fetal loss in the third trimester of pregnancy, with an optimal cut-off of around 25% (23.2%). The optimal cut-offs of EFW discordance for the prediction of single fetal loss were different in each gestational age window. Conclusion: The accuracy of EFW discordance in predicting single fetal loss in twin pregnancies varies during the third trimester of pregnancy. The degree of fetal weight discordance associated with fetal loss decreases during the third trimester, suggesting that the weight discordance threshold for intervention should vary according to gestational age.
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