Abdominal circumference ratio for the diagnosis of intertwin birth weight discordance

Simões, Teresinha; Júlio, Catarina; Cordeiro, Alexandra; Cohen, Álvaro; Silva, Abel; Blickstein, Isaac

doi:10.1515/jpm.2010.124

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…They found that an AC ratio of ≥1.3 was the best prediction of severe BW discordance. 8 In this recent study, these findings could not be confirmed. However, when using a cut-off of 1.2 in our study, severe BW discordance was seen significantly more often compared with the group with an AC ratio less than 1.2 (16.7% vs 0.8%, p < 0.01).…”

Section: Discussionmentioning

confidence: 59%

“…Because it has been thought that EFW discordance is not very accurate in predicting BW discordance, other methods have been sought. According to Simoes et al ., the AC ratio (calculated as the AC of the larger twin divided by AC of the smaller twin) alone predicts BW discordance better than the EFW discrepancy. They found that an AC ratio of ≥1.3 was the best prediction of severe BW discordance .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, an AC ratio of at least 1.2 was used to indicate a significant difference between both fetuses. For comparison with literature, an AC ratio of 1.3 8 and a CRL discordance of 11% 16 were also considered. Weight discordance at birth was calculated as the intertwin difference in BW expressed as a percentage of the heaviest twin; a value of ≥20% was defined as severe BW discordance.…”

Section: Methodsmentioning

confidence: 99%

“…Regular ultrasound assessments are used to measure fetal biometry in order to estimate the fetal weight and weight discordance. Assessing the degree of intertwin weight discordance can be performed by calculating either the estimated fetal weight (EFW), from measurements of head circumference (HC), abdominal circumference (AC) and femur length (FL) 7 or the ratio between both AC measurements within a pair 8 or intertwin crown-rump length (CRL) discrepancy at the first-trimester ultrasound. 9,10 The aim of this study was to assess the accuracy of the various sonographical estimations of size or weight discordance at various gestational ages (GAs) in the prediction of severe weight discordance at birth.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonographic prediction of birth weight discordance in twin pregnancies

et al. 2015

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Intertwin birth weight discordance is best predicted by an intertwin EFW discordance at the last ultrasound. If discordance is not suspected by ultrasound, the vast majority had no birth weight discordance. In case of birth weight discordance, the presence of at least one growth-restricted twin is very likely. However, because around 20% of concordantly grown twin pairs comprise at least one intrauterine growth restriction infant, one cannot rely on weight discordance alone.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasonographic prediction of birth weight discordance in twin pregnancies

et al. 2015

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“…The authors also wonder about the best cut-off of EFW difference to describe severe discordance. As EFW is a poor predictor of discordance (because of the ± situation that exists [4,5]), one should aim for a higher value (i.e. 25%-30% difference) to avoid over diagnosis.…”

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confidence: 99%

Multiple gestation: more research challenges to come

Blickstein

2016

Journal of Perinatal Medicine

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Nearly 1500 papers were published in the past 5 years with the subject heading of "twin" or "multiple pregnancies". This figure undoubtedly represents the ever increasing interest in this group of high-risk pregnancies. It is very impossible to encompass the myriad issues that caught the attention of clinicians when dealing with difficult clinical cases related to twins and triplets which prompted research. This issue of the Journal of Perinatal Medicine includes 10 papers on various aspects of multiple pregnancy and birth. Three papers deal with the quarter-century-old issue of discordant birth weight [1]. In the first, Biron-Shental and her colleagues [2] evaluated the possible association between intermediate birth weight discordance (> 20% difference) and infertility treatment. As in all likelihood the two embryos were conceived by the same method of infertility treatment [intracytoplasmic sperm injection (ICSI) vs. in vitro fertilization (IVF), ovulation induction vs. IVF, fresh vs. thawed embryos, etc.], the authors unsurprisingly found similar discordant levels as well as similar outcomes. As the authors did not detail the incidence of nulliparas (but the average parity) one is unable to appreciate the influence of this important confounding variable. The second paper reviews available data on outcomes related to estimated fetal weight (EFW) and crown-rump length (CRL) discordance [3]. Whereas the former was found to be associated with adverse outcomes, the latter was not. The authors also wonder about the best cut-off of EFW difference to describe severe discordance. As EFW is a poor predictor of discordance (because of the ± situation that exists [4,5]), one should aim for a higher value (i.e. 25%-30% difference) to avoid over diagnosis. Moreover, it appears that discordance, per se, is not that important unless the smaller twin is small for gestational age (SGA) or exhibits clear growth restriction on repeated scans [i.e. selective intrauterine growth restriction (IUGR)] [6]. In fact, moderate levels of discordance have been shown to be an adaptive measure to increase gestational age.The authors rightly noted the differences between the mechanism and significance of selective IUGR in monochorionic (MC) and dichorionic (DC) twins.Three papers of this batch discuss various aspects of monochorionicity. The Lisbon research group repeated their seminal study related to the prospective risk of intrauterine fetal death in MC twins [7]. Despite the publication of several studies on this subject, significant differences exist in recruitment and management of these sets. Thus, the paper of Simoes and her colleagues [6] showed that, with doubling of the sample size over time since the last report in 2006, and with implementation of intensive prenatal surveillance, a relatively low unexpected fetal death rate after 33 weeks' gestation could be achieved. These findings evidently do not support elective preterm birth for uncomplicated MC twins proposed by several authorities. At present it appears that close surveil...

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