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First Trimester Growth Discordance & Adverse Pregnancy Outcomes in Dichorionic Twins.
MedLine Citation:
PMID:  22744892     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: To estimate the association of first trimester growth discordance and adverse pregnancy outcomes in dichorionic twin pregnancies. Methods: A retrospective cohort study of all consecutive women with dichorionic twin pregnancies undergoing ultrasound between 7-14 weeks gestation. Study groups were defined by the presence of ≥ 11% crown-rump length (CRL) discordance. Pregnancies were excluded if one twin was demised at initial ultrasound or if a termination was performed. Primary outcomes were <20 week loss of either fetus (SAB), fetal anomaly, and fetal demise after 20 weeks (stillbirth). Secondary outcomes included growth restriction, admission to the neonatal intensive care unit (NICU), and preterm delivery <34 weeks. Results: Of 805 dichorionic twin pregnancies undergoing first trimester ultrasound, 610 met the inclusion criteria; 86 of whom had ≥ 11% CRL discordance. Of these, 9 (10.5%) had a fetal loss <20 weeks (risk ratio (RR) 7.8, 95% confidence interval (CI) 3.0-20.5). In the surviving pregnancies, an increased risk of fetal anomalies was seen (27.3% vs 17.4%, RR 1.6, 95% CI 1.1-2.4). In surviving pregnancies unaffected by anomalies, no increased risk of stillbirth, growth restriction, NICU admission, or delivery <34 weeks was noted in the discordant group. A post-hoc power analysis demonstrated 80% power to detect a 5-fold increase in the risk of stillbirth and 90% power to detect a 2-fold increase in other outcomes. Conclusion: Dichorionic pregnancies where a CRL discordance ≥ 11% is noted are at increased risk for fetal loss prior to 20 weeks and fetal anomalies. However, patients can be reassured that, in the absence of structural anomalies, CRL discordance does not appear to be associated with other adverse outcomes in continuing pregnancies, although our power to detect small increases in the risk of stillbirth may be limited by sample size. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Lorie M Harper; Kimberly A Roehl; Anthony O Odibo; Alison G Cahill
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-29
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:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-29     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 © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Department of Obstetrics and Gynecology, Washington University in St. Louis. harperl@wudosis.wustl.edu.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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