title: Antenatal Surveillance in Twin Pregnancies Using the Biophysical Profile.
abstract: Objectives-The nonstress test is currently the most widely used modality for antenatal surveillance in twin pregnancies, with a quoted false-positive rate of 11%-12%. Our objective was to report our experience with the sonographic portion of the biophysical profile in twin pregnancies as the primary screening modality.Methods-Women with twin pregnancies delivered by a single maternal-fetal medicine practice from 2005 to 2013 were included. We excluded monoamniotic twins. Twin pregnancies began weekly sonography for the biophysical profile starting at 32 to 33 weeks, or earlier if indicated. The nonstress test was performed if the sonographic biophysical profile score was less than 8 of 8. We reviewed biophysical profile scores and outcomes for all patients who delivered at 33 weeks or later to assess the false-positive rate for the biophysical profile, as well as the incidence of intrauterine fetal death (IUFD) after initiation of antenatal surveillance.Results-A total of 539 twin pregnancies were included. The incidence of IUFD per patient was 2 per 539 (0.4%; 95% confidence interval [CI], 0.1%-1.3%), and the incidence of IUFD per fetus was 2 per 1078 (0.19%; 95% CI, 0.05%-0.7%). The overall positive screen rate was 24 per 539 (4.45%; 95% CI, 3.0%-6.5%). The false-positive screen rate, defined as an abnormal biophysical profile that did not diagnose an IUFD or lead to delivery, was 10 per 539 (1.9%; 95% CI, 1.0%-3.4%).Conclusions-In twin pregnancies the use of the sonographic biophysical profile for routine antenatal surveillance has a low false-positive rate, with a very low incidence of IUFD. The sonographic biophysical profile should be considered as a primary mode for antenatal surveillance in twin pregnancies, with a reflex nonstress test for an abnormal score.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
authors.forename: Whitney
authors.initials: W
authors.lastname: Booker
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Fox
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
authors.forename: Simi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
authors.forename: Rachel
authors.initials: R
authors.lastname: Carroll
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Saltzman
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.).
authors.forename: Chad K
authors.initials: CK
authors.lastname: Klauser
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York USA (W.B., N.S.F., S.G., R.C., D.H.S., C.K.K., A.R.); Maternal-Fetal Medicine Associates, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.); and Carnegie Imaging for Women, PLLC, New York, New York USA (N.S.F., S.G., D.H.S., C.K.K., A.R.). arebarber@mfmnyc.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
mesh_terms: D000328:Adult; D004200:Diseases in Twins / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D009518:New York / Q000453:epidemiology; D011247:Pregnancy; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D011296:Prenatal Diagnosis / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000706:statistics & numerical data*; D057832:Watchful Waiting / Q000379:methods / Q000706:statistics & numerical data
keywords: antenatal testing; biophysical profile; obstetric ultrasound; twins