title: Outcome prediction in monochorionic diamniotic twin pregnancies with moderately discordant amniotic fluid.
abstract: OBJECTIVE
  The aim of this study was to identify predictors of twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) in monochorionic diamniotic (MCDA) twin pregnancies with moderate amniotic fluid discordance (mAFD).
  
  
  METHODS
  Monochorionic twins with mAFD (n = 45; gestational age, 15-29 weeks) were assessed for extent of fluid discordance, fetal growth discordance and fetal cardiac dysfunction, and were followed longitudinally. A prediction algorithm was constructed for TTTS and sIUGR and validated in an unrelated cohort (n = 52).
  
  
  RESULTS
  Cardiac dysfunction could not predict TTTS or sIUGR. Twins below 20 weeks of gestation with a fluid discordance of ≥ 3.1 cm had a risk of TTTS of 85.7%. Sensitivity for TTTS was nevertheless only 55%. An intertwin weight discordance of ≥ 25% had 63% sensitivity and 76% specificity for sIUGR without TTTS.
  
  
  CONCLUSIONS
  The outcome of MCDA twins with mAFD remains unpredictable, yet high-risk and low-risk subgroups for TTTS can be identified based on severity of fluid discordance and gestational age.
authors.affiliation: University Hospitals Leuven, Division of Woman and Child, Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Van Mieghem
authors.forename: E
authors.initials: E
authors.lastname: Eixarch
authors.forename: L
authors.initials: L
authors.lastname: Gucciardo
authors.forename: E
authors.initials: E
authors.lastname: Done
authors.forename: I
authors.initials: I
authors.lastname: Gonzales
authors.forename: D
authors.initials: D
authors.lastname: Van Schoubroeck
authors.forename: L
authors.initials: L
authors.lastname: Lewi
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
authors.forename: J
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000653:Amniotic Fluid / Q000000981:diagnostic imaging*; D001530:Belgium / Q000453:epidemiology; D001699:Biometry; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D013030:Spain / Q000453:epidemiology; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal