Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 2/2019

01-02-2019 | Maternal-Fetal Medicine

The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes

Authors: Xinning Chen, Qiongjie Zhou, Xirong Xiao, Xiaotian Li

Published in: Archives of Gynecology and Obstetrics | Issue 2/2019

Login to get access

Abstract

Purpose

To investigate the value of ultrasound approaching delivery to predict isolated inter-twin discordance and adverse perinatal outcomes.

Methods

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.

Results

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.

Conclusion

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.
Appendix
Available only for authorised users
Literature
1.
Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, Bode CL, Koopman-Esseboom C, Visser GH (2008) Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG 115:58–67CrossRefPubMed
2.
Chauhan SP, Scardo JA, Hayes E, Abuhamad AZ, Berghella V (2010) Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol 203:305–315CrossRefPubMed
3.
4.
5.
Jahanfar S, Lim K (2017) Adverse maternal outcomes and birth weight discordance in twin gestation: British Columbia, Canadian data. Int J Womens Health 9:871–878CrossRefPubMedPubMedCentral
6.
Kalish RB, Gupta M, Perni SC, Berman S, Chasen ST (2004) Clinical significance of first trimester crown–rump length disparity in dichorionic twin gestations. Am J Obstet Gynecol 191:1437–1440CrossRefPubMed
7.
D’Antonio F, Khalil A, Dias T, Thilaganathan B (2013) Crown–rump length discordance and adverse perinatal outcome in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol 41:621–626CrossRefPubMed
8.
Johansen ML, Oldenburg A, Rosthoj S, Cohn MJ, Rode L, Tabor A (2014) Crown–rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies? Ultrasound Obstet Gynecol 43:277–283CrossRefPubMed
9.
Nakayama S, Ishii K, Kawaguchi H, Yamamoto R, Murata M, Hayashi S, Mitsuda N (2014) Perinatal complications of monochorionic diamniotic twin gestations with discordant crown–rump length determined at mid-first trimester. J Obstet Gynaecol Res 40:418–423CrossRefPubMed
10.
D’Antonio F, Khalil A, Morlando M, Thilaganathan B (2015) 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 38:22–28CrossRefPubMed
11.
D’Antonio F, Khalil A, Thilaganathan B (2014) Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG 121:422–429CrossRefPubMed
12.
Gratacos E, Lewi L, Munoz B, Acosta-Rojas R, Hernandez-Andrade E, Martinez JM, Carreras E, Deprest J (2007) A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 30:28–34CrossRefPubMed
13.
Gaziano EP, Gaziano C, Terrell CA, Hoekstra RE (2001) The cerebroplacental Doppler ratio and neonatal outcome in diamnionic monochorionic and dichorionic twins. J Matern Fetal Med 10:371–375CrossRefPubMed
14.
Caravello JW, Chauhan SP, Morrison JC, Magann EF, Martin JJ, Devoe LD (1997) Sonographic examination does not predict twin growth discordance accurately. Obstet Gynecol 89:529–533CrossRefPubMed
15.
Chamberlain P, Murphy M, Comerford FR (1991) How accurate is antenatal sonographic identification of discordant birthweight in twins? Eur J Obstet Gynecol Reprod Biol 40:91–96CrossRefPubMed
16.
van de Waarsenburg MK, Hack KE, Rijpma RJ, Mulder EJ, Pistorius L, Derks JB (2015) Ultrasonographic prediction of birth weight discordance in twin pregnancies. Prenat Diagn 35:906–912CrossRefPubMed
17.
Van Mieghem T, Deprest J, Klaritsch P, Gucciardo L, Done E, Verhaeghe J, Lewi L (2009) Ultrasound prediction of intertwin birth weight discordance in monochorionic diamniotic twin pregnancies. Prenat Diagn 29:240–244CrossRefPubMed
18.
Chang YL, Chang TC, Chang SD, Cheng PJ, Chao AS, Hsieh PC, Soong YK (2006) Sonographic prediction of significant intertwin birth weight discordance. Eur J Obstet Gynecol Reprod Biol 127:35–40CrossRefPubMed
19.
Gernt PR, Mauldin JG, Newman RB, Durkalski VL (2001) Sonographic prediction of twin birth weight discordance. Obstet Gynecol 97:53–56PubMed
20.
Hehir MP, Breathnach FM, Hogan JL, Mcauliffe FM, Geary MP, Daly S, Higgins J, Hunter A, Morrison JJ, Burke G, Mahony R, Dicker P, Tully E, Malone FD (2017) Prenatal prediction of significant intertwin birthweight discordance using standard second and third trimester sonographic parameters. Acta Obstet Gynecol Scand 96:472–478CrossRefPubMed
21.
22.
Danon D, Melamed N, Bardin R, Meizner I (2008) Accuracy of ultrasonographic fetal weight estimation in twin pregnancies. Obstet Gynecol 112:759–764CrossRefPubMed
23.
Dudley NJ (2005) A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol 25:80–89CrossRefPubMed
24.
Stirrup OT, Khalil A, D’Antonio F, Thilaganathan B (2015) Fetal growth reference ranges in twin pregnancy: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol 45:301–307CrossRefPubMed
25.
Stirrup OT, Khalil A, D’Antonio F, Thilaganathan B (2017) Patterns of second- and third-trimester growth and discordance in twin pregnancy: analysis of the Southwest Thames obstetric research collaborative (STORK) multiple pregnancy cohort. Fetal Diagn Ther 41:100–107CrossRefPubMed
26.
Wei J, Wu QJ, Zhang TN, Shen ZQ, Liu H, Zheng DM, Cui H, Liu CX (2016) Complications in multiple gestation pregnancy: a cross-sectional study of ten maternal-fetal medicine centers in China. Oncotarget 7:30797–30803PubMedPubMedCentral
27.
Kalish RB, Thaler HT, Chasen ST, Gupta M, Berman SJ, Rosenwaks Z, Chervenak FA (2004) First- and second-trimester ultrasound assessment of gestational age. Am J Obstet Gynecol 191:975–978CrossRefPubMed
28.
Dias T, Mahsud-Dornan S, Thilaganathan B, Papageorghiou A, Bhide A (2010) First-trimester ultrasound dating of twin pregnancy: are singleton charts reliable? BJOG 117:979–984CrossRefPubMed
29.
Tunon K, Eik-Nes SH, Grottum P, Von During V, Kahn JA (2000) Gestational age in pregnancies conceived after in vitro fertilization: a comparison between age assessed from oocyte retrieval, crown–rump length and biparietal diameter. Ultrasound Obstet Gynecol 15:41–46CrossRefPubMed
30.
Stenhouse E, Hardwick C, Maharaj S, Webb J, Kelly T, Mackenzie FM (2002) Chorionicity determination in twin pregnancies: how accurate are we? Ultrasound Obstet Gynecol 19:350–352CrossRefPubMed
31.
Bromley B, Benacerraf B (1995) Using the number of yolk sacs to determine amnionicity in early first trimester monochorionic twins. J Ultrasound Med 14:415–419CrossRefPubMed
32.
Sarris I, Ioannou C, Ohuma EO, Altman DG, Hoch L, Cosgrove C, Fathima S, Salomon LJ, Papageorghiou AT (2013) Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH-21st Project. BJOG 120(Suppl 2):33–37CrossRefPubMed
33.
Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK (1985) Estimation of fetal weight with the use of head, body, and femur measurements–a prospective study. Am J Obstet Gynecol 151:333–337CrossRefPubMed
34.
Hadlock FP, Harrist RB, Carpenter RJ, Deter RL, Park SK (1984) Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements. Radiology 150:535–540CrossRefPubMed
35.
Ong S, Smith AP, Fitzmaurice A, Campbell D (1999) Estimation of fetal weight in twins: a new mathematical model. Br J Obstet Gynaecol 106:924–928CrossRefPubMed
36.
Ott WJ, Doyle S, Flamm S, Wittman J (1986) Accurate ultrasonic estimation of fetal weight. Prospective analysis of new ultrasonic formulas. Am J Perinatol 3:307–310CrossRefPubMed
37.
Shepard MJ, Richards VA, Berkowitz RL, Warsof SL, Hobbins JC (1982) An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol 142:47–54CrossRefPubMed
38.
Combs CA, Rosenn B, Miodovnik M, Siddiqi TA (2000) Sonographic EFW and macrosomia: is there an optimum formula to predict diabetic fetal macrosomia? J Matern Fetal Med 9:55–61PubMed
39.
Lewi L, Gucciardo L, Van Mieghem T, de Koninck P, Beck V, Medek H, Van Schoubroeck D, Devlieger R, De Catte L, Deprest J (2010) Monochorionic diamniotic twin pregnancies: natural history and risk stratification. Fetal Diagn Ther 27:121–133CrossRefPubMed
40.
Rustico MA, Consonni D, Lanna M, Faiola S, Schena V, Scelsa B, Introvini P, Righini A, Parazzini C, Lista G, Barretta F, Ferrazzi E (2017) Selective intrauterine growth restriction in monochorionic twins: changing patterns in umbilical artery Doppler flow and outcomes. Ultrasound Obstet Gynecol 49:387–393CrossRefPubMed
41.
Acharya G, Wilsgaard T, Berntsen GK, Maltau JM, Kiserud T (2005) Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol 192:937–944CrossRefPubMed
42.
D’Antonio F, Khalil A, Dias T, Thilaganathan B (2013) Weight discordance and perinatal mortality in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound Obstet Gynecol 41:643–648CrossRefPubMed
43.
Hartley RS, Hitti J, Emanuel I (2002) Size-discordant twin pairs have higher perinatal mortality rates than nondiscordant pairs. Am J Obstet Gynecol 187:1173–1178CrossRefPubMed
44.
Vergani P, Locatelli A, Ratti M, Scian A, Pozzi E, Pezzullo JC, Ghidini A (2004) Preterm twins: what threshold of birth weight discordance heralds major adverse neonatal outcome? Am J Obstet Gynecol 191:1441–1445CrossRefPubMed
45.
Branum AM, Schoendorf KC (2003) The effect of birth weight discordance on twin neonatal mortality. Obstet Gynecol 101:570–574PubMed
46.
47.
Chen ZL, Liu J, Feng ZC (2013) Experts’ consensus on the criteria for the diagnosis and grading of neonatal asphyxia in China. Transl Pediatr 2:64–65PubMedPubMedCentral
48.
Moret L, Mesbah M, Chwalow J, Lellouch J (1993) Internal validation of a measurement scale: relation between principal component analysis, Cronbach’s alpha coefficient and intra-class correlation coefficient. Rev Epidemiol Sante Publique 41:179–186PubMed
49.
Davies MJ, Moore VM, Willson KJ, Van Essen P, Priest K, Scott H, Haan EA, Chan A (2012) Reproductive technologies and the risk of birth defects. N Engl J Med 366:1803–1813CrossRefPubMed
50.
McDonald SD, Murphy K, Beyene J, Ohlsson A (2005) Perinatel outcomes of singleton pregnancies achieved by in vitro fertilization: a systematic review and meta-analysis. J Obstet Gynaecol Can 27:449–459CrossRefPubMed
51.
Masheer S, Maheen H, Munim S (2015) Perinatal outcome of twin pregnancies according to chorionicity: an observational study from tertiary care hospital. J Matern Fetal Neonatal Med 28:23–25CrossRefPubMed
52.
Jacobsson B, Ladfors L, Milsom I (2004) Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 104:727–733CrossRefPubMed
53.
Phillips JK, Skelly JM, King SE, Bernstein IM, Higgins ST (2018) Associations of maternal obesity and smoking status with perinatal outcomes. J Matern Fetal Neonatal Med 31:1620–1626CrossRefPubMed
54.
Zhao DP, Cambiaso O, Otano L, Lewi L, Deprest J, Sun LM, Duan T, Oepkes D, Shapiro S, De Paepe ME, Lopriore E (2015) Veno-venous anastomoses in twin-twin transfusion syndrome: a multicenter study. Placenta 36:911–914CrossRefPubMed
55.
Galea P, Jain V, Fisk NM (2005) Insights into the pathophysiology of twin–twin transfusion syndrome. Prenat Diagn 25:777–785CrossRefPubMed
56.
Favre R, Koch A, Weingertner AS, Sananes N, Trieu NT, Kohler M, Guerra F, Nisand I (2013) Vascular pattern in monochorionic placentas with spontaneous TAPS and TTTS with residual anastomoses after laser: a case–control study. Prenat Diagn 33:979–982PubMed
57.
Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon LJ, Sotiriadis A, Thilaganathan B, Ville Y (2016) ISUOG practice guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 47:247–263CrossRefPubMed
58.
Townsend R, Khalil A (2016) Twin pregnancy complicated by selective growth restriction. Curr Opin Obstet Gynecol 28:485–491CrossRefPubMed
59.
Khalil A, D’Antonio F, Dias T, Cooper D, Thilaganathan B (2014) Ultrasound estimation of birth weight in twin pregnancy: comparison of biometry algorithms in the STORK multiple pregnancy cohort. Ultrasound Obstet Gynecol 44:210–220CrossRefPubMed
60.
Hoopmann M, Kagan KO, Yazdi B, Grischke EM, Abele H (2011) Prediction of birth weight discordance in twin pregnancies by second- and third- trimester ultrasound. Fetal Diagn Ther 30:29–34CrossRefPubMed
61.
Reberdao MA, Martins L, Torgal M, Viana R, Seminova T, Casal E, Hermida M, Blickstein I (2010) The source of error in the estimation of intertwin birth weight discordance. J Perinat Med 38:671–674CrossRefPubMed
62.
Esinler D, Bircan O, Esin S, Sahin EG, Kandemir O, Yalvac S (2015) Finding the best formula to predict the fetal weight: comparison of 18 formulas. Gynecol Obstet Invest 80:78–84CrossRefPubMed
63.
Leombroni M, Liberati M, Fanfani F, Pagani G, Familiari A, Buca D, Manzoli L, Scambia G, Rizzo G, D’Antonio F (2017) Diagnostic accuracy of ultrasound in predicting birth-weight discordance in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol 50:442–450CrossRefPubMed
64.
65.
Gaziano EP, Gaziano C, Terrell CA, Hoekstra RE (2001) The cerebroplacental Doppler ratio and neonatal outcome in diamnionic monochorionic and dichorionic twins. J Matern Fetal Med 10:371–375CrossRefPubMed
66.
Chittacharoen A, Leelapattana P, Rangsiprakarn R (2000) Prediction of discordant twins by real-time ultrasonography combined with umbilical artery velocimetry. Ultrasound Obstet Gynecol 15:118–121CrossRefPubMed
67.
Queiros A, Blickstein I, Valdoleiros S, Felix N, Cohen A, Simoes T (2017) Prediction of birth weight discordance from fetal weight estimations at 21–24 weeks’ scans in monochorionic and dichorionic twins. J Matern Fetal Neonatal Med 30:1944–1947CrossRefPubMed
Metadata
Title
The value of ultrasound in predicting isolated inter-twin discordance and adverse perinatal outcomes
Authors
Xinning Chen
Qiongjie Zhou
Xirong Xiao
Xiaotian Li
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 2/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-5002-3

Other articles of this Issue 2/2019

Archives of Gynecology and Obstetrics 2/2019 Go to the issue

Maternal-Fetal Medicine

Neonatal outcomes in term pregnancies treated with antenatal corticosteroids for suspected pre-term labor

Maternal-Fetal Medicine

The participation rate of migrant women in gestational diabetes screening in Austria: a retrospective analysis of 3293 births

Gynecologic Oncology

Quality of life and oncological outcome in endometrial cancer patients after vaginal brachytherapy: comparison of two dosing schemes

Review

Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a systematic review

Gynecologic Endocrinology and Reproductive Medicine

Low-dose mifepristone increased angiogenesis in a manner involving AQP1

Review

Thyroid function and thyroid disorders during pregnancy: a review and care pathway