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Role of fetal intertwin difference in middle cerebral artery peak systolic velocity in predicting neonatal twin anemia–polycythemia sequence
Author(s) -
Tavares de Sousa M.,
Fonseca A.,
Hecher K.
Publication year - 2019
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.20116
Subject(s) - medicine , fetus , monochorionic twins , middle cerebral artery , significant difference , obstetrics , umbilical artery , mean difference , receiver operating characteristic , cardiology , pregnancy , confidence interval , biology , genetics , ischemia
Objectives To evaluate the relationship between the fetal intertwin difference in middle cerebral artery peak systolic velocity (MCA‐PSV) and intertwin difference in hemoglobin (Hb) concentration at birth in monochorionic diamniotic (MCDA) twin pregnancies in order to assess its potential role in the prediction of twin anemia–polycythemia sequence (TAPS). Methods This was a retrospective cohort study of MCDA twin pregnancies delivered between January 2012 and January 2018. All pregnancies with measurements of MCA‐PSV within 7 days prior to delivery and in which neonatal Hb concentration was available were included. The correlation between fetal intertwin difference in MCA‐PSV, expressed in multiples of the median (MoM), and neonatal intertwin difference in Hb concentration was investigated. Receiver–operating characteristics (ROC) curve analysis was used to assess the performance of fetal intertwin difference in MCA‐PSV for predicting intertwin difference in Hb > 90 th centile at birth. Results A total of 154 out of 256 MC twin pregnancies fulfilled the inclusion criteria. Fetal intertwin difference in MCA‐PSV MoM correlated positively with neonatal intertwin difference in Hb concentration ( r = 0.79; P < 0.001). The 90 th centile for intertwin difference in Hb was 7.25 g/dL. There were 15 (9.7%) cases with a Hb difference ≥ 7.25 g/dL at birth. ROC curve analysis showed a high accuracy of fetal intertwin MCA‐PSV MoM difference for the prediction of neonatal intertwin Hb difference ≥ 7.25 g/dL at birth (area under the ROC curve, 0.976 (95% CI, 0.935–0.993); P = 0.012). The optimal cut‐off for intertwin MCA‐PSV MoM difference was 0.373, with a sensitivity of 93.3% (95% CI, 68.1–99.8%) and a specificity of 95.7% (95% CI, 90.8–98.4%). The positive predictive value was 70% (95% CI, 45.7–88.1%) and the negative predictive value was 99.3% (95% CI, 95.9–100%). Conclusion Our findings show that fetal intertwin MCA‐PSV MoM difference is a good predictor of neonatal intertwin Hb concentration difference > 90 th centile and potentially of TAPS. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.