[go: up one dir, main page]
More Web Proxy on the site http://driver.im/ Skip to main content

Advertisement

Springer Nature Link
Log in

Intra-abdominal umbilical venous diameter and abdominal circumference discordance at 15–20 weeks’ gestation: simple markers in transverse abdominal plane to predict adverse pregnancy outcomes in monochorionic diamniotic twins

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to investigate the association between simple markers in fetal abdominal plane, intra-abdominal umbilical venous diameter (DIUV) and abdominal circumference (AC) discordance at 15–20 weeks’ gestation, and adverse pregnancy outcomes in monochorionic diamniotic (MCDA) twins.

Methods

We performed a retrospective analysis of MCDA twins with two live fetuses examined at 15–20 weeks from Jun 2020 to Dec 2021 at Beijing Obstetrics and Gynecology Hospital. Measurement of fetal AC and DIUV was performed according to standard protocols. Twin pregnancies with major fetal structural anomalies, chromosomal abnormalities, miscarriage, and twin reversed arterial perfusion sequence were excluded. DIUV and AC discordance in MCDA twins with an adverse pregnancy outcome was compared with a normal pregnancy outcome. Furthermore, the performance of DIUV and AC discordance in predicting adverse pregnancy outcomes in MCDA twins was assessed.

Results

A total of 105 women with MCDA twin pregnancies were enrolled, contributing 179 visits. Adverse pregnancy outcomes occurred in 33.3% (35/105) of cases in our study. The intra-observer and inter-observer intraclass correlation coefficient (ICC) of both AC and DIUV were very good or excellent. There was no statistical difference in AC and DIUV discordance (%) between 15–16, 17–18, and 19–20 weeks (χ2 = 3.928, P = 0.140; χ2 = 2.840, P = 0.242). Both AC and DIUV discordance were greater in twins with adverse pregnancy outcomes than that in twins with normal pregnancy outcome at each pregnancy periods. Both AC discordance (OR 1.2, 95% CI 1.1–1.3) and DIUV discordance (OR 1.2, 95% CI 1.1–1.2) were associated with adverse pregnancy outcomes. The AUC for predicting adverse pregnancy outcomes by AC discordance was 0.75 (95% CI 0.68–0.83), with a sensitivity of 58.7% (95% CI 51.9–64.5) and a specificity of 86.2% (95% CI 81.7–88.4). The AUC for predicting adverse pregnancy outcomes by DIUV was 0.78 (95% CI 0.70–0.86), with sensitivity and specificity of 65.1% (95% CI 58.1–70.3) and 86.2% (95% CI 81.7–88.4), respectively.

Conclusions

The AC discordance and DIUV discordance could predict adverse pregnancy outcomes in MCDA twins. When these simple markers occurred, intensive surveillance was recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
£29.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

MCDA:

Monochorionic diamniotic

TTTS:

Twin–twin transfusion syndrome

sFGR:

Selective fetal growth restriction

CRL:

Crown–rump length

NT:

Nuchal translucency

AC:

Abdominal circumference

EFW:

Estimated fetal weight

DIUV :

Intra-abdominal umbilical venous diameter

TRAP:

Twin reversed arterial perfusion

TAPS:

Twin anemia polycythemia sequence

ISUOG:

International Society of Ultrasound in Obstetrics and Gynecology

ICC:

Intraclass correlation coefficient

OR:

Odds ratio

AUC:

Area under the receiving operator characteristic curve

SFLP:

Selective fetoscopic laser photocoagulation

IUV:

Intra-abdominal umbilical venous

References

  1. Li X, Xuan Y, Wang J, Wang L, Papageorghiou AT, Wu Q (2022) Crown-rump length discordance, increased nuchal translucency, and detection of fetal structural anomalies in twin pregnancies in the first trimester: 5 years of experience in a Tertiary Hospital in China. J Ultrasound Med 41(4):971–982. https://doi.org/10.1002/jum.15784

    Article  PubMed  Google Scholar 

  2. Cimpoca B, Syngelaki A, Litwinska E, Muzaferovic A, Nicolaides KH (2020) Increased nuchal translucency at 11–13 weeks’ gestation and outcome in twin pregnancy. Ultrasound Obstet Gynecol 55(3):318–325. https://doi.org/10.1002/uog.21935

    Article  CAS  PubMed  Google Scholar 

  3. Litwinska E, Syngelaki A, Cimpoca B, Sapantzoglou I, Nicolaides KH (2020) Intertwin discordance in fetal size at 11–13 weeks’ gestation and pregnancy outcome. Ultrasound Obstet Gynecol 55(2):189–197. https://doi.org/10.1002/uog.21923

    Article  CAS  PubMed  Google Scholar 

  4. Radhakrishnan P, Thakar S, Chauhan S, Acharya V, Shettikeri A (2020) Combination of “Markers” and the consequent importance of fetal abdominal circumference in the first trimester for predicting complications specific to monochorionic twin pregnancies. Fetal Diagn Ther 47(7):580–586. https://doi.org/10.1159/000505812

    Article  PubMed  Google Scholar 

  5. Zhang A, Stolk TT, Lopriore E, Sun L, Duan T, Oepkes D (2022) Second-trimester abdominal circumference discordance and adverse perinatal outcomes in monochorionic twins. J Matern Fetal Neonatal Med 35(25):7316–7321. https://doi.org/10.1080/14767058.2021.1947227

    Article  CAS  PubMed  Google Scholar 

  6. Allaf MB, Campbell WA, Vintzileos AM, Haeri S, Javadian P, Shamshirsaz AA, Ogburn P, Figueroa R, Wax J, Markenson G, Chavez MR, Ravangard SF, Ruano R, Sangi-Haghpeykar H, Salmanian B, Meyer M, Johnson J, Ozhand A, Davis S, Borgida A, Belfort MA, Shamshirsaz AA (2014) Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? J Ultrasound Med 33(9):1573–1578. https://doi.org/10.7863/ultra.33.9.1573

    Article  PubMed  Google Scholar 

  7. Couck I, van der Merwe J, Russo F, Richter J, Aertsen M, Cauwberghs B, Van Aelst M, Lewi L (2022) Umbilical venous diameter and flow in monochorionic diamniotic twin pregnancy: association with placental sharing and fetal demise. Ultrasound Obstet Gynecol 60(4):514–522. https://doi.org/10.1002/uog.24903

    Article  CAS  PubMed  Google Scholar 

  8. Khalil A, Beune I, Hecher K, Wynia K, Ganzevoort W, Reed K, Lewi L, Oepkes D, Gratacos E, Thilaganathan B, Gordijn SJ (2019) Consensus definition and essential reporting parameters of selective fetal growth restriction in twin pregnancy: a Delphi procedure. Ultrasound Obstet Gynecol 53(1):47–54. https://doi.org/10.1002/uog.19013

    Article  CAS  PubMed  Google Scholar 

  9. Gratacós E, Lewi L, Muñoz B, Acosta-Rojas R, Hernandez-Andrade E, Martinez JM, Carreras E, Deprest J (2007) A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 30(1):28–34. https://doi.org/10.1002/uog.4046

    Article  PubMed  Google Scholar 

  10. Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon LJ, Sotiriadis A, Thilaganathan B, Ville Y (2016) ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 47(2):247–263. https://doi.org/10.1002/uog.15821

    Article  CAS  PubMed  Google Scholar 

  11. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M (1999) Staging of twin–twin transfusion syndrome. J Perinatol 19(8 Pt 1):550–555. https://doi.org/10.1038/sj.jp.7200292

    Article  CAS  PubMed  Google Scholar 

  12. Chen J, Zhang J, Liu Y, Wei X, Yang Y, Zou G, Zhang Y, Duan T, Sun L (2021) Fetal growth standards for Chinese twin pregnancies. BMC Pregnancy Child 21(1):436. https://doi.org/10.1186/s12884-021-03926-y

    Article  Google Scholar 

  13. Dias T, Arcangeli T, Bhide A, Napolitano R, Mahsud-Dornan S, Thilaganathan B (2011) First-trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gynecol 38(5):530–532. https://doi.org/10.1002/uog.8956

    Article  CAS  PubMed  Google Scholar 

  14. Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva CF, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W (2022) ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 59(6):840–856. https://doi.org/10.1002/uog.24888

    Article  CAS  PubMed  Google Scholar 

  15. Kanazawa S, Muromoto J, Ozawa K, Mikami M, Ogawa K, Wada S, Sago H (2001) Reliability and characteristics of ultrasound measurement of fetal umbilical venous blood flow volume according to the site of measurement. J Med Ultrason 47(2):305–312. https://doi.org/10.1007/s10396-019-00999-3

    Article  Google Scholar 

  16. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  CAS  PubMed  Google Scholar 

  17. Litwinska E, Syngelaki A, Cimpoca B, Frei L, Nicolaides KH (2020) Outcome of twin pregnancy with two live fetuses at 11–13 weeks’ gestation. Ultrasound Obstet Gynecol 55(1):32–38. https://doi.org/10.1002/uog.21892

    Article  CAS  PubMed  Google Scholar 

  18. D’Antonio F, Khalil A, Thilaganathan B, Southwest Thames Obstetric Research Collaborative (STORK) (2014) Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG 121(4):422–429. https://doi.org/10.1111/1471-0528.12467

    Article  CAS  PubMed  Google Scholar 

  19. D’Antonio F, Herrera M, Oronzii L, Khalil A (2022) Solomon technique vs selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome: systematic review and meta-analysis of maternal and perinatal outcomes. Ultrasound Obstet Gynecol 60(6):731–738. https://doi.org/10.1002/uog.26095

    Article  CAS  PubMed  Google Scholar 

  20. Donepudi R, Espinoza J, Nassr AA, Belfort MA, Shamshirsaz AA, Sanz Cortes M (2021) Prediction of post-laser fetal death in selective growth restriction complicating twin-twin transfusion syndrome using standardized definitions. Ultrasound Obstet Gynecol 58(5):738–743. https://doi.org/10.1002/uog.23519

    Article  CAS  PubMed  Google Scholar 

  21. Snowise S, Moise KJ, Johnson A, Bebbington MW, Papanna R (2015) Donor death after selective fetoscopic laser surgery for twin-twin transfusion syndrome. Obstet Gynecol 126(1):74–80. https://doi.org/10.1097/AOG.0000000000000858

    Article  PubMed  Google Scholar 

  22. Finneran MM, Templin MA, Stephenson CD (2019) Risk of donor demise after laser therapy for twin-twin transfusion when complicated by growth discordance and abnormal umbilical artery Doppler findings. J Matern Fetal Neonatal Med 32(8):1332–1336. https://doi.org/10.1080/14767058.2017.1404983

    Article  PubMed  Google Scholar 

  23. O’Connor C, McAuliffe FM, Breathnach FM, Geary M, Daly S, Higgins JR, Dornan J, Morrison JJ, Burke G, Higgins S, Mooney E, Dicker P, Manning F, McParland P, Malone FD, Perinatal Ireland Research Consortium (2013) Prediction of outcome in twin pregnancy with first and early second trimester ultrasound. J Matern Fetal Neonatal Med 26(10):1030–1035. https://doi.org/10.3109/14767058.2013.766701

    Article  PubMed  Google Scholar 

  24. Wang L, Zhou Q, Zhou C, Wang J, Shi C, Long B, Hu L, Peng Y, Liu Y, Xu G (2022) Z-score reference ranges for umbilical vein diameter and blood flow volume in normal fetuses. J Ultrasound Med 41(4):907–916. https://doi.org/10.1002/jum.15774

    Article  PubMed  Google Scholar 

  25. DeVore GR, Epstein A (2022) Computing Z-score equations for clinical use to measure fetal umbilical vein size and flow using six independent variables of age and size. J Ultrasound Med 41(8):1949–1960. https://doi.org/10.1002/jum.15872

    Article  PubMed  Google Scholar 

  26. Rigano S, Bozzo M, Padoan A, Mustoni P, Bellotti M, Galan HL, Ferrazzi E (2008) Small size-specific umbilical vein diameter in severe growth restricted fetuses that die in utero. Prenat Diagn 28(10):908–913. https://doi.org/10.1002/pd.2054

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to express our great appreciation to all our colleagues who referred pregnancy women to us and the enrolled MCDA twin pregnancy women who trusted us.

Funding

This work was supported by Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital ‘Excellent Youth’ Plan Special Funds (NO.YQRC201811), Beijing Hospitals Authority Youth Programme (QML20191403).

Author information

Authors and Affiliations

  1. Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, China

    Xiaofei Li, Jijing Han, Juan Zhang & Qingqing Wu

  2. Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China

    Haili Jiang

Authors
  1. Xiaofei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jijing Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haili Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qingqing Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

XL: Manuscript writing, Project and protocol development, Data Collection, management and analysis; JH: Project development, Manuscript editing; JZ: Data Collection, Manuscript editing; QW: Corresponding author of this paper, Project and protocol development and supervising; HJ: Data collection, Antenatal care providing, Intrauterine treatment performed when needed.

Corresponding author

Correspondence to Qingqing Wu.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

The authors assert that all procedures contributing to this study comply with the ethical standards of the relevant national guidelines on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. This study was approved by the Ethics Committees of the Beijing Obstetrics and Gynecology Hospital, Capital Medical University(2020-KY-028-01).

Informed consent

Patients who participated in this study signed an informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 33 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, X., Han, J., Zhang, J. et al. Intra-abdominal umbilical venous diameter and abdominal circumference discordance at 15–20 weeks’ gestation: simple markers in transverse abdominal plane to predict adverse pregnancy outcomes in monochorionic diamniotic twins. Arch Gynecol Obstet 309, 1951–1958 (2024). https://doi.org/10.1007/s00404-023-07085-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-023-07085-7

Keywords

Search

Navigation