Intertwin discrepancy in middle cerebral artery peak systolic velocity and third-trimester fetal growth restriction in monochorionic-diamniotic twin pregnancy

Ultrasound Obstet Gynecol. 2016 Jul;48(1):66-71. doi: 10.1002/uog.14944. Epub 2016 Jun 8.

Abstract

Objectives: To assess the role of intertwin discrepancy in middle cerebral artery peak systolic velocity (MCA-PSV) for the prediction of late selective intrauterine growth restriction (sIUGR) at birth and birth weight discrepancy of > 25% (BW-25) in otherwise uncomplicated monochorionic-diamniotic (MCDA) twin pregnancies.

Methods: This was a cohort study including all MCDA pregnancies followed in a tertiary fetal medicine unit between 2008 and 2013. Exclusion criteria were referral after first trimester, abnormal karyotype, structural anomalies, twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence and sIUGR detected before 28 weeks. MCA-PSV values of both twins measured in the second trimester (18-24 weeks) and early third trimester (26-32 weeks) were converted in multiples of the median (MoM). sIUGR was defined as birth weight < 5(th) centile. The relationship between MCA-PSV discrepancy, sIUGR and BW-25 was assessed by logistic regression analysis. Receiver-operating characteristics (ROC) curves were used to ascertain the predictive value of MCA-PSV discrepancy for such complications.

Results: In total, 136 MCDA twin pregnancies were included in the analysis. Thirty (22.1%) were complicated with sIUGR at birth and 12 (8.8%) were complicated with BW-25. Logistic regression analysis identified MCA-PSV discrepancy as an independent predictor for sIUGR. ROC curves identified third-trimester MCA-PSV discrepancy as the best predictor for both sIUGR (area under ROC curve (AUC), 0.73 (95% CI, 0.62-0.85)) and BW-25 (AUC, 0.79 (95% CI, 0.65-0.93)). The optimal cut-off point for MCA-PSV discrepancy was 0.30 MoM (sensitivity, 70% and specificity, 69% for sIUGR; sensitivity, 83% and specificity, 72% for BW-25).

Conclusion: In MCDA twin pregnancies, MCA-PSV discrepancy is associated with both sIUGR at birth and BW discordance. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Keywords: MCA-PSV; intertwin discordance; late IUGR; middle cerebral artery; monochorionic twins; selective IUGR.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Blood Flow Velocity
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Fetal Growth Retardation / diagnostic imaging
  • Fetal Growth Retardation / physiopathology*
  • Humans
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / physiopathology*
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Trimester, Third
  • Pregnancy, Twin
  • Pulsatile Flow
  • Retrospective Studies
  • Twins*
  • Ultrasonography, Prenatal*