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Prediction of selective fetal growth restriction and twin‐to‐twin transfusion syndrome in monochorionic twins
Author(s) -
Memmo A,
Dias T,
MahsudDornan S,
Papageorghiou AT,
Bhide A,
Thilaganathan B
Publication year - 2012
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2011.03250.x
Subject(s) - monochorionic twins , twin to twin transfusion syndrome , fetus , medicine , receiver operating characteristic , gestation , obstetrics , pregnancy , biology , genetics
Please cite this paper as: Memmo A, Dias T, Mahsud‐Dornan S, Papageorghiou A, Bhide A, Thilaganathan B. Prediction of selective fetal growth restriction and twin‐to‐twin transfusion syndrome in monochorionic twins. BJOG 2012;119:417–421. Objective To study the correlation of discrepancy between crown–rump length (CRL) and nuchal translucency (NT) in monochorionic twins at 11–14 weeks of gestation and subsequent development of twin‐to‐twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR). Design Retrospective cohort study. Setting Tertiary‐care Fetal Medicine Unit, London. Sample Monochorionic twin pregnancies with known outcome. Methods Inter‐twin discrepancy was calculated as a percentage of the larger CRL and smaller NT and compared among those developing TTTS, those with sFGR and those with normal outcome. Receiver operating characteristic (ROC) curves were constructed to evaluate the performance of inter‐twin discrepancy in prediction of sFGR and TTTS. Main outcome measures Development of TTTS and sFGR. Results A total of 242 monochorionic twin pregnancies were studied (102 TTTS, 36 sFGR and 104 controls). The median CRL discrepancy in the sFGR group (11.9%) was significantly higher ( P < 0.001) than in the TTTS group (3.8%) and control group (3.5%). Median inter‐twin NT discrepancies were not significantly different ( P = 0.869) between sFGR and both TTTS and control groups (15.6%, 16.7% and 14.8%, respectively). Discrepancy in CRL performs well as a screening test for sFGR (area under ROC curve = 0.89), but not for TTTS (area under ROC curve = 0.58). Conclusions First‐trimester CRL discrepancy in monochorionic twins is a marker for subsequent development of sFGR rather than TTTS. Inter‐twin NT discrepancy does not appear to be significantly different in these two groups from those with normal outcome.