Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?

M. Baraa Allaf, Winston A. Campbell, Anthony M. Vintzileos, Sina Haeri, Pouya Javadian, Amir A. Shamshirsaz, Paul Ogburn, Reinaldo Figueroa, Joseph Wax, Glenn Markenson, Martin R. Chavez, Samadh F. Ravangard, Rodrigo Ruano, Haleh Sangi-Haghpeykar, Bahram Salmanian, Marjorie Meyer, Jeffery Johnson, Ali Ozhand, Sarah Davis, Adam BorgidaMichael A. Belfort, Alireza A. Shamshirsaz

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.

Methods: We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven earlyonset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed.

Results: Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes.

Conclusions: In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.

Original languageEnglish (US)
Pages (from-to)1573-1578
Number of pages6
JournalJournal of Ultrasound in Medicine
Volume33
Issue number9
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Fetal Weight
Twin Pregnancy
Second Pregnancy Trimester
Femur Head
Fetofetal Transfusion
Ultrasonography
Obstetrics
Fetus
ROC Curve
Necrotizing Enterocolitis
Fetal Death
Apgar Score
Premature Birth
Growth
Area Under Curve
Sepsis
Cohort Studies
Retrospective Studies
Logistic Models
Hemorrhage

Keywords

  • Monochorionic twins
  • Nuchal translucency
  • Obstetric ultrasound
  • Second trimester
  • Twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

Allaf, M. B., Campbell, W. A., Vintzileos, A. M., Haeri, S., Javadian, P., Shamshirsaz, A. A., ... Shamshirsaz, A. A. (2014). Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? Journal of Ultrasound in Medicine, 33(9), 1573-1578. https://doi.org/10.7863/ultra.33.9.1573

Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? / Allaf, M. Baraa; Campbell, Winston A.; Vintzileos, Anthony M.; Haeri, Sina; Javadian, Pouya; Shamshirsaz, Amir A.; Ogburn, Paul; Figueroa, Reinaldo; Wax, Joseph; Markenson, Glenn; Chavez, Martin R.; Ravangard, Samadh F.; Ruano, Rodrigo; Sangi-Haghpeykar, Haleh; Salmanian, Bahram; Meyer, Marjorie; Johnson, Jeffery; Ozhand, Ali; Davis, Sarah; Borgida, Adam; Belfort, Michael A.; Shamshirsaz, Alireza A.

In: Journal of Ultrasound in Medicine, Vol. 33, No. 9, 01.01.2014, p. 1573-1578.

Research output: Contribution to journalArticle

Allaf, MB, Campbell, WA, Vintzileos, AM, Haeri, S, Javadian, P, Shamshirsaz, AA, Ogburn, P, Figueroa, R, Wax, J, Markenson, G, Chavez, MR, Ravangard, SF, Ruano, R, Sangi-Haghpeykar, H, Salmanian, B, Meyer, M, Johnson, J, Ozhand, A, Davis, S, Borgida, A, Belfort, MA & Shamshirsaz, AA 2014, 'Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?', Journal of Ultrasound in Medicine, vol. 33, no. 9, pp. 1573-1578. https://doi.org/10.7863/ultra.33.9.1573
Allaf, M. Baraa ; Campbell, Winston A. ; Vintzileos, Anthony M. ; Haeri, Sina ; Javadian, Pouya ; Shamshirsaz, Amir A. ; Ogburn, Paul ; Figueroa, Reinaldo ; Wax, Joseph ; Markenson, Glenn ; Chavez, Martin R. ; Ravangard, Samadh F. ; Ruano, Rodrigo ; Sangi-Haghpeykar, Haleh ; Salmanian, Bahram ; Meyer, Marjorie ; Johnson, Jeffery ; Ozhand, Ali ; Davis, Sarah ; Borgida, Adam ; Belfort, Michael A. ; Shamshirsaz, Alireza A. / Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?. In: Journal of Ultrasound in Medicine. 2014 ; Vol. 33, No. 9. pp. 1573-1578.
@article{df46fb45ad2646328ca852e47c8f33d7,
title = "Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?",
abstract = "Objectives: To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.Methods: We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20{\%} difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven earlyonset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed.Results: Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79{\%} and 80{\%}, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes.Conclusions: In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.",
keywords = "Monochorionic twins, Nuchal translucency, Obstetric ultrasound, Second trimester, Twin-twin transfusion syndrome",
author = "Allaf, {M. Baraa} and Campbell, {Winston A.} and Vintzileos, {Anthony M.} and Sina Haeri and Pouya Javadian and Shamshirsaz, {Amir A.} and Paul Ogburn and Reinaldo Figueroa and Joseph Wax and Glenn Markenson and Chavez, {Martin R.} and Ravangard, {Samadh F.} and Rodrigo Ruano and Haleh Sangi-Haghpeykar and Bahram Salmanian and Marjorie Meyer and Jeffery Johnson and Ali Ozhand and Sarah Davis and Adam Borgida and Belfort, {Michael A.} and Shamshirsaz, {Alireza A.}",
year = "2014",
month = "1",
day = "1",
doi = "10.7863/ultra.33.9.1573",
language = "English (US)",
volume = "33",
pages = "1573--1578",
journal = "Journal of Ultrasound in Medicine",
issn = "0278-4297",
publisher = "American Institute of Ultrasound in Medicine",
number = "9",

}

TY - JOUR

T1 - Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?

AU - Allaf, M. Baraa

AU - Campbell, Winston A.

AU - Vintzileos, Anthony M.

AU - Haeri, Sina

AU - Javadian, Pouya

AU - Shamshirsaz, Amir A.

AU - Ogburn, Paul

AU - Figueroa, Reinaldo

AU - Wax, Joseph

AU - Markenson, Glenn

AU - Chavez, Martin R.

AU - Ravangard, Samadh F.

AU - Ruano, Rodrigo

AU - Sangi-Haghpeykar, Haleh

AU - Salmanian, Bahram

AU - Meyer, Marjorie

AU - Johnson, Jeffery

AU - Ozhand, Ali

AU - Davis, Sarah

AU - Borgida, Adam

AU - Belfort, Michael A.

AU - Shamshirsaz, Alireza A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives: To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.Methods: We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven earlyonset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed.Results: Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes.Conclusions: In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.

AB - Objectives: To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.Methods: We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven earlyonset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed.Results: Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes.Conclusions: In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.

KW - Monochorionic twins

KW - Nuchal translucency

KW - Obstetric ultrasound

KW - Second trimester

KW - Twin-twin transfusion syndrome

UR - http://www.scopus.com/inward/record.url?scp=84907225850&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907225850&partnerID=8YFLogxK

U2 - 10.7863/ultra.33.9.1573

DO - 10.7863/ultra.33.9.1573

M3 - Article

C2 - 25154937

AN - SCOPUS:84907225850

VL - 33

SP - 1573

EP - 1578

JO - Journal of Ultrasound in Medicine

JF - Journal of Ultrasound in Medicine

SN - 0278-4297

IS - 9

ER -