Discordance in twins: Association versus prediction

Cerra, Chiara; D’Antonio, F.

doi:10.1016/j.bpobgyn.2022.08.001

“…Accurate prenatal prediction and recognition of discordant fetal growth are critical for deciding suitable management strategies. However, although intensive fetal surveillance using prenatal ultrasonography has been associated with the prediction and recognition of discordant fetal growth, the extent to which labor-intensive surveillance is effective in clinical practice is still controversial [5,16]. Moreover, studies on fetal biometric parameters for predicting discordant growth in twins have reported inconsistent results regarding accuracy [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…Considering the adverse perinatal outcomes of discordant growth, accurate prenatal prediction and recognition of discordant growth are crucial. Currently, comparing fetal biometry parameters via ultrasound to evaluate the degree of inter-twin fetal growth discordance has become a routine obstetric practice [5][6][7]. The predictive value of fetal growth parameters include crown-lump length (CRL), biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL).…”

mentioning

confidence: 99%

Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: A retrospective cohort study

Li

¹

,

Wu

²

,

Zhou

³

et al. 2023

Preprint

0

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Background Accurate prenatal recognition of discordant fetal growth in twins is critical for deciding suitable management strategies. We explored the predictive value of the level of maternal second-trimester placental growth factor (PLGF) as a novel indicator of discordant fetal growth. Methods A total of 860 women pregnant with twins were enrolled, including 168 women with monochorionic twins (31 cases of discordant fetal growth and 137 without) and 692 with dichorionic twins (79 cases of discordant fetal growth and 613 without). Maternal second-trimester PLGF concentrations were measured via immunofluorescence. Results Maternal second-trimester PLGF levels were significantly lower in women pregnant with twins who subsequently developed discordant fetal growth than in those who did not (monochorionic twin pregnancy: P < 0.001; dichorionic twin pregnancy: P < 0.001). A 3–4 fold difference in median PLGF concentrations was detected between the two groups with both monochorionic and dichorionic twin pregnancies. Maternal second-trimester PLGF levels were significantly correlated with birth weight differences (monochorionic twin pregnancy: r = − 0.331, P < 0.001; dichorionic twin pregnancy: r = − 0.234, P < 0.001). A receiver operating characteristic curve was used to evaluate the predictive efficiency. In monochorionic twin pregnancies, the area under the curve (AUC) was 0.751 (95% confidence interval [CI]: 0.649–0.852), and the cutoff value was 187.5 pg/mL with a sensitivity of 77.4% and specificity of 71.0%. In dichorionic twin pregnancies, the AUC was 0.716 (95% CI; 0.655–0.777), and the cutoff value was 252.5 pg/mL with a sensitivity of 65.1% and specificity of 69.6%. Based on the above cutoff values, univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (OR) for the PLGF levels. After adjustment for potential confounding factors, low PLGF concentrations still significantly increased the risk of discordant fetal growth (monochorionic twin pregnancy: adjusted OR: 7.039, 95% CI: 2.798–17.710, P < 0.001; dichorionic twin pregnancy: adjusted OR: 4.279, 95% CI: 2.572–7.120, P < 0.001). Conclusions A low maternal second-trimester PLGF level is considered a remarkable risk factor and potential predictor of discordant fetal growth. This finding provides a complementary screening strategy for the prediction of discordant fetal growth and offers a unique perspective for the subsequent research in this field.

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“…Discordant fetal growth is calculated by determining the difference between the EFW of the larger and smaller twin, divided by the EFW of the larger twin [3 ▪▪ ,4]. Although discordant growth has been shown to be independently associated with adverse outcomes, there is no standard definition for pathologic discordance, with most defining this cutoff at 20–25% [4,24].…”

Section: Discordant Growthmentioning

confidence: 99%

“…Some discordant growth patterns, even in the absence of FGR, have been shown to be associated with adverse outcomes including preterm delivery and preeclampsia [3 && ]. Unfortunately, societal recommendations about how to manage discordant growth in the absence of FGR are lacking, although weight discordance greater than 25% is one of the criteria for diagnosing FGR according to ISUOG as well as other expert consensus statements [24,28,29].…”

Section: Discordant Growthmentioning

confidence: 99%

“…Discordant fetal growth among twin gestations, or differences in the sonographic EFW between the two fetuses, has been suggested as an important parameter when evaluating twins [24]. Discordant fetal growth is calculated by determining the difference between the EFW of the larger and smaller twin, divided by the EFW of the larger twin [3 ▪▪ ,4].…”

Section: Discordant Growthmentioning

confidence: 99%

See 1 more Smart Citation

Fetal growth disorders in twin gestations

Blumenfeld

¹

,

Anderson

²

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTwin gestations account for approximately 3% of all births. Although there appear to be physiologic differences in the third trimester growth of twins compared with singleton gestations, reasons for this remain unclear. As growth-restricted fetuses and neonates are at increased risk for adverse outcomes, there is a clinical need to optimize our ability to delineate normally from pathologically grown twins.Recent findingsRecent studies have addressed current limitations in the way growth restriction is diagnosed in twin gestations. Twin-specific fetal and neonatal growth charts have been shown to decrease the number of cases inappropriately labeled as growth restricted compared with singleton nomograms. In addition, individual growth assessment (IGA) is a promising method of diagnosing pathological growth using each fetus's growth potential rather than a comparison of the estimated fetal weight with population nomograms.SummaryThere is a recent focus on improving our understanding of physiologic and pathologic twin growth. The increased use of twin-specific growth curves is likely to result in a decrease in the incidence of FGR diagnosis among twin gestations and could improve the outcomes of twins currently misclassified as FGR. Future research will hopefully clarify the reasons behind differences seen in twin versus singleton third trimester twin growth.

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Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: a retrospective cohort study

Li,

Wu,

Zhou

et al. 2024

BMC Pregnancy Childbirth

1

0

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Background Accurate prenatal recognition of discordant fetal growth in twins is critical for deciding suitable management strategies. We explored the predictive value of the level of maternal second-trimester placental growth factor (PLGF) as a novel indicator of discordant fetal growth. Methods A total of 860 women pregnant with twins were enrolled, including 168 women with monochorionic twins (31 cases of discordant fetal growth and 137 without) and 692 with dichorionic twins (79 cases of discordant fetal growth and 613 without). Maternal second-trimester PLGF concentrations were measured via immunofluorescence. Results Maternal second-trimester PLGF levels were significantly lower in women pregnant with twins who subsequently developed discordant fetal growth than in those who did not (monochorionic twin pregnancy: P < 0.001; dichorionic twin pregnancy: P < 0.001). A 3–4 fold difference in median PLGF concentrations was detected between the two groups with both monochorionic and dichorionic twin pregnancies. Maternal second-trimester PLGF levels were significantly correlated with birth weight differences (monochorionic twin pregnancy: r = − 0.331, P < 0.001; dichorionic twin pregnancy: r = − 0.234, P < 0.001). A receiver operating characteristic curve was used to evaluate the predictive efficiency. In monochorionic twin pregnancies, the area under the curve (AUC) was 0.751 (95% confidence interval [CI]: 0.649–0.852), and the cutoff value was 187.5 pg/mL with a sensitivity of 77.4% and specificity of 71.0%. In dichorionic twin pregnancies, the AUC was 0.716 (95% CI; 0.655–0.777), and the cutoff value was 252.5 pg/mL with a sensitivity of 65.1% and specificity of 69.6%. Based on the above cutoff values, univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (OR) for the PLGF levels. After adjustment for potential confounding factors, low PLGF concentrations still significantly increased the risk of discordant fetal growth (monochorionic twin pregnancy: adjusted OR: 7.039, 95% CI: 2.798–17.710, P < 0.001; dichorionic twin pregnancy: adjusted OR: 4.279, 95% CI: 2.572–7.120, P < 0.001). Conclusions A low maternal second-trimester PLGF level is considered a remarkable risk factor and potential predictor of discordant fetal growth. This finding provides a complementary screening strategy for the prediction of discordant fetal growth and offers a unique perspective for the subsequent research in this field.

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Discordance in twins: Association versus prediction

Cited by 5 publications

References 38 publications

Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: A retrospective cohort study

Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: A retrospective cohort study

Fetal growth disorders in twin gestations

Predictive value of maternal serum placental growth factor levels for discordant fetal growth in twins: a retrospective cohort study

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