Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure

Khalil, Asma; Beune, Irene; Hecher, Kurt; Wynia, Klaske; Ganzevoort, Wessel; Reed, Keith; Lewi, Liesbeth; Oepkes, Dick; Gratacós, Eduard; Thilaganathan, B.; Gordijn, Sanne J.

doi:10.1002/uog.19013

Cited by 162 publications

(172 citation statements)

References 25 publications

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“…In MC twin pregnancies, selective intrauterine growth restriction is commonly used as a synonym of weight discordance. Selective intrauterine growth restriction is defined as the presence of a twin with estimated fetal weight less than 10th percentile and it is commonly associated with a discrepancy in fetal weight ≥25% . Therefore, prenatal detection of discordant growth in MC twins should prompt a careful Doppler evaluation of the umbilical artery Doppler flow pattern in order to stratify the risk of adverse pregnancy outcome …”

Section: Discussionmentioning

confidence: 99%

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Mascio

Acharya

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this systematic review was to quantify the association between birthweight discordance and neonatal morbidity in twin pregnancies. Material and methods MEDLINE, Embase and Cinahl databases were searched. Studies reporting the occurrence of morbidity in twins affected compared with those not affected by birthweight discordance were included. The primary outcome was composite neonatal morbidity (including neurological, respiratory, infectious morbidities, abnormal acid‐base status and necrotizing enterocolitis). The secondary outcomes were the individual morbidities. Sub‐group analysis according to chorionicity, gestational age at birth and fetal weight (smaller vs larger twin) was also performed. Random‐effect head‐to‐head meta‐analyses were used to analyze the data. Results Twenty studies (10 851 twin pregnancies) were included. The risk of composite morbidity was significantly higher in the pregnancies with birthweight discordance ≥15% (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.0‐1.9), ≥20% (OR 2.2, 95% CI 1.40‐3.45), ≥25% (OR 2.5, 95% CI 1.8‐3.6), and ≥30% (OR 3.4, 95% CI 2.2‐3.2). In dichorionic twins, birthweight discordance ≥15% (OR 2.4, 95% CI 1.65‐3.46), ≥20% (OR 2.2, 95% CI 1.3‐3.8), ≥25% (OR 2.7, 95% CI 1.4‐5.1) and ≥30% (OR 3.6, 95% CI 2.3‐5.7) were all significantly associated with composite neonatal morbidity. Analysis of monochorionic twins was hampered by the very small number of included studies, which precluded adequate statistical power. Monochorionic twins with a birthweight discordance ≥20% were at significantly higher risk of composite neonatal morbidity (OR 2.2, 95% CI 1.1‐4.9) compared with those presenting with lesser degree of discordance. When stratifying the analysis according to gestational age at birth and fetal size, twins with birthweight discordance ≥15%, 20%, 25% and 30% delivered at ≥34 weeks were at higher risk of neonatal morbidity compared with controls, but there was no difference in the risk of morbidity between the larger and the smaller twin in the discordant pair. Conclusions Birthweight discordance is associated with neonatal morbidity in twin pregnancies. The strength of this association persists for dichorionic twins. It was not possible to extrapolate robust evidence on monochorionic twins due to the low power of the analysis due to the small number of included studies.

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Section: Discussionmentioning

confidence: 99%

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Mascio

Acharya

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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“…The most commonly used definition of selective fetal growth restriction is when one fetus has an estimated fetal weight below the 10th centile, with many clinicians additionally requiring an intertwin estimated fetal weight discordance of greater than 25% . Estimated fetal weight discordance is calculated with the following formula:

\frac{false(weight of the larger twin - weight of the smaller twin false) \times 100}{weight of the larger twin}

…”

Section: Antenatal Care Of Twin Pregnanciesmentioning

confidence: 99%

Good clinical practice advice: Management of twin pregnancy

Renzo¹,

Fonseca²,

Gratacós³

et al. 2019

Intl J Gynecology & Obste

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“…A key condition to consider is sFGR, which complicates between 10% and 15% of monochorionic twin pregnancies. A consensus definition of sFGR was recently reached. Moreover, Gratacós et al .…”

Section: Characteristics Of 39 Studies Evaluating Interventions For Smentioning

confidence: 99%

Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction

Sileo

Duffy

Townsend

et al. 2019

Ultrasound in Obstet & Gyne

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The recent investigation of variation in outcome reporting in studies of twin-to-twin transfusion syndrome has highlighted the problem of variable and inconsistently defined outcome reporting in studies of twin-to-twin transfusion syndrome (TTTS).(1) Similar heterogeneity in outcome reporting has been identified across women's and newborn health including pre-eclampsia, childbirth trauma and endometriosis.(2-8) This article is protected by copyright. All rights reserved.

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Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure

Cited by 162 publications

References 25 publications

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Good clinical practice advice: Management of twin pregnancy

Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction

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