PurposeTo investigate the value of ultrasound approaching delivery to predict isolated inter-twin discordance and adverse perinatal outcomes.MethodsWe 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.ResultsTwo 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%. EFWD22% 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.ConclusionThe 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.
[1]Fudan Univ, Obstet & Gynecol Hosp, 419 Fangxie Rd, Shanghai 200011, Peoples R China;
[2]Shanghai Key Lab Female Reprod Endocrine Related, Shanghai, Peoples R China;
[3]UiT Arctic Univ Norway, Dept Clin Med, Womens Hlth & Perinatol Res Grp, Tromso, Norway;
[4]Fudan Univ, Inst Biomed Sci, Shanghai, Peoples R China
(8.0+极速模式)