| Monochorionic diamniotic twin pregnancy: timing and duration of sonographic surveillance for detection of twin-twin transfusion syndrome. | |
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MedLine Citation:
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PMID: 21357550 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Objective- Twin-twin transfusion syndrome complicates up to 15% of monochorionic diamniotic gestations. Current recommendations for sonographic surveillance in monochorionic diamniotic pregnancies for detection of twin-twin transfusion syndrome vary. Our objective was to determine an appropriate frequency of sonographic surveillance to optimize detection of twin-twin transfusion syndrome in monochorionic diamniotic gestations. Methods- A retrospective cohort analysis of all nonanomalous monochorionic diamniotic twins delivered at the University of North Carolina over a 9-year period was performed. The rate and gestational age of twin-twin transfusion syndrome onset were calculated. The time to the diagnosis of twin-twin transfusion syndrome was evaluated by a Kaplan-Meier survival curve; clinical factors at initial sonography were examined for their use in prediction of twin-twin transfusion syndrome. Results- Of the 577 twin deliveries, 145 (25%) were monochorionic diamniotic and included for analysis. The rate of twin-twin transfusion syndrome was 17.93% (n = 26). The mean frequency of surveillance ± SD before diagnosis of twin-twin transfusion syndrome was 3.1 ± 2.1 weeks. The mean gestational age at diagnosis of twin-twin transfusion syndrome was 21.3 ± 3.4 weeks (range, 15-29 weeks). Both a discordant maximum vertical amniotic fluid pocket (>65% difference) and a discordant estimated fetal weight (>25% difference) at initial sonography showed a significantly shorter time to diagnosis of twin-twin transfusion syndrome (P < .0001). Conclusions- Evaluation for twin-twin transfusion syndrome should begin in the second trimester. Weekly surveillance for those pregnancies with estimated fetal weight or maximum vertical pocket discordance is recommended. For those with a concordant estimated fetal weight and maximum vertical pocket, sonographic evaluation every 2 weeks is warranted to 28 to 30 weeks. After that, development of twin-twin transfusion syndrome is less likely, and a different paradigm of antenatal testing may be reasonable. |
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Authors:
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Alissa Carver; Sina Haeri; Julie Moldenhauer; Honor M Wolfe; William Goodnight |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Volume: 30 ISSN: 1550-9613 ISO Abbreviation: J Ultrasound Med Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-01 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8211547 Medline TA: J Ultrasound Med Country: United States |
Other Details:
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Languages: eng Pagination: 297-301 Citation Subset: IM |
Affiliation:
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MHSA, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, 3010 Old Clinic Building, CB 7516, Chapel Hill, NC 27599-7516 USA. sinahaeri@gmail.com. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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