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Weight Discordance And Perinatal Mortality In Twins: The Stork Multiple Pregnancy Cohort.
MedLine Citation:
PMID:  23355123     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Twin birthweight (BW) discordance is an important determinant of adverse perinatal outcome. Despite knowledge of this association, the degree of actual BW or estimated fetal weight (EFW) discordance that justifies elective delivery is yet to be established. The main aim of this study was to ascertain the performance of BW and ultrasound EFW discordance in the prediction of perinatal loss in twin pregnancies. The second aim was to investigate other variables potentially associated with perinatal loss. METHODS: A retrospective study of all twin pregnancy births from a large regional cohort of 9 hospitals over a ten year period. Inter-twin BW and ultrasound EFW discordance were related to stillbirth and neonatal death of one or both twins obtained from a mandatory national register. Receiver operating characteristic (ROC), survival and logistic regression analyses were performed to evaluate the contribution of weight discordance in determining perinatal loss. RESULTS: A total of 2,161 twin pregnancies were included in the analysis. A BW discordance of ≥25% was associated with the highest AUC for the prediction of stillbirth and neonatal death (BW AUC=0.72; 95% CI: 0.65-0.80). The perinatal loss in twins with a BW discordance of ≥25% was significantly greater (60.9 per 1,000 fetuses) than that in twins with an EFW discordance <25% (8.6 per 1,000 fetuses) (p<0.0001); the predictive accuracy was similar using either BW or ultrasound EFW discordance (EFW AUC=0.69; 95% CI: 0.62-0.77, p=0.62). Logistic regression analysis demonstrated that BW discordance and gestational age, but not chorionicity or individual fetal size percentile, were independently associated with perinatal mortality. CONCLUSIONS: An EFW discordance of ≥25% represents the optimal cut-off for the prediction of stillbirth and neonatal mortality irrespective of chorionicity or individual fetal size. A policy of increased fetal surveillance commencing from 26 weeks' gestation and elective delivery by 38 weeks might be reasonable, but require confirmation in large scale prospective trials.
Authors:
Francesco D'Antonio; Asma Khalil; Tiran Dias; Basky Thilaganathan;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-25
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:  2013-1-28     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.
Affiliation:
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
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