Document Detail

Customized growth chart for twin gestations to optimize identification of small for gestational age fetuses at risk for intra-uterine fetal death.
MedLine Citation:
PMID:  23334992     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Customized growth charts developed for singleton pregnancies have been shown to be more effective at identifying small for gestational age (SGA) pregnancies at risk for intrauterine fetal death (IUFD). We sought to compare the association between SGA and IUFD in twins using customized growth charts designed for twin gestations versus using one designed for singletons. STUDY DESIGN: This is a retrospective cohort study using a database including singleton and twin pregnancies seen for ultrasound between 16 and 20 weeks gestation. After excluding preterm births, congenital anomalies, and stillbirths, we identified 51,150 singleton births. Coefficients for significant physiological and pathological variables affecting fetal growth were derived using backward stepwise multiple regression for singletons. The same process was repeated including only twin births (1608 pairs) in the regression models adjusting for chorionicity to generate a chart for twins. The association between SGA <10th percentile defined using the twin versus singleton customized charts and IUFD were compared. Statistical analyses including OR, 95% confidence interval (CI), and screening accuracy using each chart were performed. RESULTS: The derived coefficients for fetal growth for twins are different from those for singletons: with lower constants and root mean squared error (3422 and 288.9 in twins; versus 3543 and 416 in singletons, respectively). Among 3786 twin infants, IUFD was seen in 123 (3.2%). The numbers of pregnancies identified as SGA were: 575 (15.2%), and 504(13.3%) by the singleton and twin charts, respectively. Pregnancies classified as SGA by the twin specific customized chart were at a significant risk for IUFD (AOR 2.3, 95%CI: 1.4-3.5), compared with those classified by the singleton customized chart (AOR 1.2, 95% CI: 0.7-2.0). CONCLUSION: Customized charts designed specifically for twins are more efficient at identifying twin pregnancies at risk for IUFD compared with those derived using singleton birth data.
Anthony O Odibo; Alison G Cahill; Katherine R Goetzinger; Lorie M Harper; Methodius G Tuuli; George A Macones
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-17
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
Division of Maternal Fetal Medicine, Ultrasound and Genetics, and Fetal Care Center, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis.
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