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First‐Trimester Sonographic Prediction of Obstetric and Neonatal Outcomes in Monochorionic Diamniotic Twin Pregnancies
Author(s) -
Allaf M. Baraa,
Vintzileos Anthony M.,
Chavez Martin R.,
Wax Joseph A.,
Ravangard Samadh F.,
Figueroa Reinaldo,
Borgida Adam,
Shamshirsaz Amir,
Markenson Glenn,
Davis Sarah,
Habenicht Rebecca,
Haeri Sina,
Ozhand Ali,
Johnson Jeffery,
Sangi-Haghpeykar Haleh,
Spiel Melissa,
Ruano Rodrigo,
Meyer Marjorie,
Belfort Michael A.,
Ogburn Paul,
Campbell Winston A.,
Shamshirsaz Alireza A.
Publication year - 2014
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.33.1.135
Subject(s) - medicine , obstetrics , confidence interval , gestational age , intrauterine growth restriction , gestation , retrospective cohort study , crown rump length , logistic regression , monochorionic twins , receiver operating characteristic , pregnancy , first trimester , surgery , genetics , biology
Objectives The purpose of this study was to investigate whether discordant nuchal translucency and crown‐rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes. Methods We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11‐week to 13‐week 6‐day sonographic examination who had serial follow‐up sonography until delivery. Isolated nuchal translucency, crown‐rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin‐twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted. Results Fifty‐four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52–0.72), and 0.54 (95% confidence interval, 0.46–0.61), respectively. Conclusions In our population, nuchal translucency, crown‐rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.