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First-Trimester Crown-Rump Length (CRL) and Nuchal Translucency (NT) Discordance in Monochorionic Twins: An Ominous Sign or a Benign Feature?

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Abstract

Background

This study aimed to evaluate the usefulness of the first-trimester crown-rump length (CRL) and nuchal translucency (NT) discordance in monochorionic diamniotic twins (MCDA) for the prediction of complications—twin–twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR) or intrauterine fetal demise (IUFD).

Methods

Intertwin discordance in the CRL and NT was calculated as a percentage of the larger CRL and NT, respectively. The performance of inter twin discordance (CRL ≥ 10% and NT≥ 20%) for predicting complications was analysed using standard statistical screening test methods.

Results

Fifty-eight MCDA twin pregnancies were studied. Out of them, 19 (32%) pregnancies resulted in one of the complications studied (4 TTTS, 10 sFGR, 5 IUFD). CRL and NT discordance showed an increased probability of developing complications positive likelihood ratio (LR+) {95% confidence interval}: 2.05 {0.46–9.23} and 1.88 {1.03–3.45}, respectively. NT discordance showed a sensitivity of 57%.

Conclusions

Although discordant first-trimester CRL and NT in monochorionic twins are poor screening tools for early prediction, if positive, they increase the risk of developing complications.

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Authors and Affiliations

  1. Apollo Centre for Fetal Medicine, New Delhi, India

    Saloni Arora, Smriti Prasad, Akshatha Sharma & Anita Kaul

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  1. Saloni Arora
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  2. Smriti Prasad
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  3. Akshatha Sharma
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  4. Anita Kaul
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Correspondence to Anita Kaul.

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The authors declare that they have no conflict of interest.

Ethical approval

Written informed consent is taken from all the patients, visiting our centre, about the use of their personal data for future studies. Also for doing reanalysis of de-identified data permission was taken from the Institutional ethics committee.

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Dr. Saloni Arora, MD, MRCOG, Fellowship Fetal Medicine, Consultant, Apollo Centre for Fetal Medicine, New Delhi, India. Dr. Smriti Prasad, MD, MRCOG, Fellowship Fetal Medicine, Consultant, Apollo Centre for Fetal Medicine, New Delhi, India. Dr. Akshatha Sharma, MD, MRCOG, Fellowship Fetal Medicine, Consultant, Apollo Centre for Fetal Medicine, New Delhi, India. Dr. Anita Kaul, MD, FRCOG, Diploma in Fetal Medicine, Clinical Coordinator and Head of Department, Apollo Centre for Fetal Medicine, New Delhi, India.

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Arora, S., Prasad, S., Sharma, A. et al. First-Trimester Crown-Rump Length (CRL) and Nuchal Translucency (NT) Discordance in Monochorionic Twins: An Ominous Sign or a Benign Feature?. J Obstet Gynecol India 70, 349–354 (2020). https://doi.org/10.1007/s13224-020-01354-0

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  • DOI: https://doi.org/10.1007/s13224-020-01354-0

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