title: First-trimester sonographic prediction of obstetric and neonatal outcomes in monochorionic diamniotic twin pregnancies.
abstract: OBJECTIVE
  The purpose of this study was to investigate whether discordant nuchal translucency and crown-rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes.
  
  
  METHODS
  We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11-week to 13-week 6-day sonographic examination who had serial follow-up sonography until delivery. Isolated nuchal translucency, crown-rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin-twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥ 20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted.
  
  
  RESULTS
  Fifty-four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52-0.72), and 0.54 (95% confidence interval, 0.46-0.61), respectively.
  
  
  CONCLUSIONS
  In our population, nuchal translucency, crown-rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Pavilion for Women-Texas Children's Fetal Center, 6651 Main St, Suite F1020, Houston, TX 77030 USA. alirezashamshirsaz@yahoo.com.
authors.forename: M Baraa
authors.initials: MB
authors.lastname: Allaf
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Vintzileos
authors.forename: Martin R
authors.initials: MR
authors.lastname: Chavez
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Wax
authors.forename: Samadh F
authors.initials: SF
authors.lastname: Ravangard
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Figueroa
authors.forename: Adam
authors.initials: A
authors.lastname: Borgida
authors.forename: Amir
authors.initials: A
authors.lastname: Shamshirsaz
authors.forename: Glenn
authors.initials: G
authors.lastname: Markenson
authors.forename: Sarah
authors.initials: S
authors.lastname: Davis
authors.forename: Rebecca
authors.initials: R
authors.lastname: Habenicht
authors.forename: Sina
authors.initials: S
authors.lastname: Haeri
authors.forename: Ali
authors.initials: A
authors.lastname: Ozhand
authors.forename: Jeffery
authors.initials: J
authors.lastname: Johnson
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.forename: Melissa
authors.initials: M
authors.lastname: Spiel
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.forename: Marjorie
authors.initials: M
authors.lastname: Meyer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.forename: Paul
authors.initials: P
authors.lastname: Ogburn
authors.forename: Winston A
authors.initials: WA
authors.lastname: Campbell
authors.forename: Alireza A
authors.initials: AA
authors.lastname: Shamshirsaz
mesh_terms: D018568:Crown-Rump Length; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging*; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D048208:Nuchal Translucency Measurement / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D059285:Pregnancy, Twin; D011379:Prognosis; D015203:Reproducibility of Results; D012127:Respiratory Distress Syndrome, Newborn / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014430:Twins, Monozygotic
keywords: crown-rump length; monochorionic twins; nuchal translucency; obstetric ultrasound; twin-twin transfusion syndrome