P19.08: Sonographically estimated fetal weight discordance and perinatal outcomes in twin pregnancies

Abstract Purpose: The aim of this study was to determine the relationships between the estimated fetal weight discordancy, which was measured by ultrasound during pregnancy, and maternal pregnancy complications and neonatal outcomes in dichorionic diamniotic twin pregnancies.Methods: We conducted a retrospective review of the medical records of 320 twin pregnancies delivered at Chilgok Kyungpook National University Hospital between January 2011 and February 2020. This study included dichorionic diamniotic twin mothers who delivered between 32+1 and 38+0 weeks of gestation. Mothers who had one fetal demise, a major anomaly, or twin-specific complications were excluded. At 20–24 weeks and 28–32 weeks of gestation, participants were divided into 2 groups: discordant twins with an estimated fetal weight difference of more than 20% and concordant twins with a weight difference of less than 20%. The maternal complications and neonatal outcomes were compared between the two groups. Results: The incidences of preeclampsia and placenta previa were significantly higher in discordant twins measured between 20 and 24 weeks compared with concordant twins, but no statistical significance was found in the neonatal outcomes between the two groups. Delivery times were earlier and neonatal weights were lower in discordant twins measured between 28 and 32 weeks. Neonatal outcomes such as ventilator use and neurodevelopment were also significantly different. Conclusion: Discordance in estimated fetal weight measured by ultrasound between 20 and 24 weeks is a risk factor for maternal preeclampsia and placenta previa, whereas discordancy at 28–32 weeks can predict poor neonatal outcomes.

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Is the fetal cerebroplacental ratio better that the estimated fetal weight in predicting adverse perinatal outcomes in a low risk cohort?

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2018.1438394 ◽

2018 ◽

Vol 32 (14) ◽

pp. 2380-2386 ◽

Cited By ~ 3

Author(s):

Christopher Flatley ◽

Sailesh Kumar

Keyword(s):

Perinatal Outcomes ◽

Low Risk ◽

Fetal Weight ◽

Cerebroplacental Ratio ◽

Adverse Perinatal Outcomes ◽

Estimated Fetal Weight

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New reference values for biometrical measurements and sonographic estimated fetal weight in twin gestations and comparison to previous normograms

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0207 ◽

2019 ◽

Vol 47 (7) ◽

pp. 757-764

Author(s):

Renana Wilkof Segev ◽

Milana Gelman ◽

Esther Maor-Sagie ◽

Alon Shrim ◽

Mordechai Hallak ◽

...

Keyword(s):

Reference Values ◽

Medical Center ◽

Normal Growth ◽

Fetal Weight ◽

Primary Analysis ◽

Monochorionic Twins ◽

Equal Distribution ◽

Wide Variability ◽

Twin Pregnancies ◽

Estimated Fetal Weight

Abstract Objective To construct new reference values for biometrical measurements and sonographic estimated fetal weight (sEFW) in twin gestations and compare them to previously published normograms. Methods A retrospective analysis of sEFW evaluations of twin gestations was performed between 2011 and 2016 in a single university-affiliated medical center. sEFW was calculated using the Hadlock 1985 formula. To avoid selection bias, one evaluation per pregnancy was randomly selected. Following mathematical transformation to obtain normality of values, normograms were constructed using a best-fit regression model for estimation of mean and standard deviation at each gestational age (GA). Normograms were validated by applying all observations to ensure equal distribution at parallel percentiles. Our normograms were then compared to previously published sEFW normograms for twin gestations. Results A total of 864 sEFW evaluations were performed on 195 twin pregnancies at 22–39 gestational weeks. Of them, 390 entered the primary analysis. The rest were left for validation. Seventy percent of the cohort were dichorionic-diamniotic twins (136/195), 16% (32/195) were monochorionic-diamniotic twins and three (1.5%) were monochorionic-monoamniotic twins. Twenty-four fetuses lacked data on chorionicity. The rest were monochorionic twins or were of unknown chorionicity. Values corresponding to the 2.5th, 10th, 50th, 90th and 97.5th percentiles for sEFW are presented for every GA. Validation by applying all 864 evaluations on constructed normograms was achieved. Comparison to previously published twins’ sEFW normograms demonstrated wide variation between curves. Conclusion New reference values for biometrical measurements and sEFW in twin gestations are presented for clinical and research use. Comparison to other curves demonstrates the wide variability and need for further investigation on twin’s normal growth.

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Perinatal Outcome of Selective Intrauterine Growth Restriction in Monochorionic Twins: Evaluation of a Retrospective Cohort in a Developing Country

Twin Research and Human Genetics ◽

10.1017/thg.2021.7 ◽

2021 ◽

pp. 1-5

Author(s):

Carolina Aquino ◽

Ana Elisa Rodrigues Baião ◽

Paulo Roberto Nassar de Carvalho

Keyword(s):

Intrauterine Growth Restriction ◽

Retrospective Cohort ◽

Umbilical Artery ◽

Perinatal Outcomes ◽

Growth Restriction ◽

Type I ◽

Monochorionic Twin ◽

Intrauterine Growth ◽

Twin Pregnancies ◽

Estimated Fetal Weight

Abstract Selective intrauterine growth restriction (sIUGR) in monochorionic twin pregnancies is associated with greater morbidity and mortality for both fetuses when compared to singleton and dichorionic pregnancies. This retrospective cohort study aimed to assess the perinatal outcomes of monochorionic twin pregnancies affected by this disorder and conducted expectantly, by analyzing the results according to the end-diastolic flow in the umbilical artery Doppler of the smaller twin (type I: persistently forward/type II: persistently absent or reversed/type III: intermittently absent or reversed). Seventy-five monochorionic diamniotic twin pregnancies with sIUGR were included in this study. sIUGR was defined by estimated fetal weight below the 3rd centile for gestational age, or below the 10th centile, when associated with at least one of the following three criteria: abdominal circumference below the 10th percentile, umbilical artery pulsatility index of the smaller twin above the 95th percentile, or estimated fetal weight discordance of 25% or more. Perinatal outcomes were analyzed from the prenatal period to hospital discharge and included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and sepsis. The mortality rate was 1.33% in this cohort. The overall morbidity rate was lower in type I twin pregnancies. In conclusion, this study shows that sIUGR type I has lower morbidity than types II and III in expectant management.

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