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Ultrasound in the prediction of birthweight discordance in dichorionic twins.

Authors
  • Lei, Ting1
  • Zheng, Ju1
  • Papageorghiou, Aris T2
  • Feng, Jie-Ling1
  • Lin, Mei-Fang1
  • Zhang, Fan3
  • Xie, Hong-Ning1
  • 1 Department of Ultrasonic Medicine, Fetal Medical Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. , (China)
  • 2 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.
  • 3 Department of Biostatistics Unit, Oncology Research Laboratory, the Cancer Hospital of Shantou University Medical College, Guangdong, China. , (China)
Type
Published Article
Journal
Acta Obstetricia Et Gynecologica Scandinavica
Publisher
Wiley (Blackwell Publishing)
Publication Date
May 01, 2021
Volume
100
Issue
5
Pages
908–916
Identifiers
DOI: 10.1111/aogs.14055
PMID: 33253418
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © 2020 Nordic Federation of Societies of Obstetrics and Gynecology.

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