Title |
Dichorionic twin ultrasound surveillance: sonography every 4 weeks significantly underperforms sonography every 2 weeks: results of the Prospective Multicenter ESPRiT Study
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Published in |
American Journal of Obstetrics & Gynecology, August 2015
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DOI | 10.1016/j.ajog.2015.07.049 |
Pubmed ID | |
Authors |
Siobhan Corcoran, Fionnuala Breathnach, Gerard Burke, Fionnuala McAuliffe, Michael Geary, Sean Daly, John Higgins, Alyson Hunter, John J. Morrison, Shane Higgins, Rhona Mahony, Patrick Dicker, Elizabeth Tully, Fergal D. Malone |
Abstract |
A two-weekly ultrasound schedule for monochorionic twins is widely endorsed. There is a lack of robust data to inform a schedule for the surveillance of dichorionic gestations. We aimed to determine how ultrasound performed at 2- or 4-weekly intervals (or 4 weekly before 32 weeks and 2 weekly thereafter) may impact the prenatal detection of fetal growth restriction (FGR) and ultimately influence timing of delivery. In a consecutive cohort of 789 dichorionic twin pregnancies prospectively recruited for the multicenter ESPRiT study, ultrasound determination of fetal growth and interrogation of umbilical and middle cerebral artery Doppler were performed every 2 weeks from 24 weeks' gestation until delivery. Complete delivery and perinatal outcome data were recorded for all pregnancies. Where delivery was prompted by FGR, abnormal umbilical artery (UA) Doppler examination or poor biophysical profile, and in the absence of ruptured membranes, onset of labor, preeclampsia or antepartum haemorrhage, the delivery was considered 'ultrasound-indicated'. For ultrasound-indicated deliveries, detection probabilities for fetal growth restriction / abnormal umbilical artery Doppler / poor biophysical were determined according to the interval between examinations, by suppressing alternate examination data. Among 789 DC twin pregnancies, 66 pairs (8%) had an "ultrasound indicated" delivery. Detection of FGR was reduced from 88% to 69% and detection of abnormal UA Doppler was reduced from 82% to 62% when a four-weekly ultrasound schedule was simulated. Both of these reductions reached statistical significance. There was a non-significant trend toward a reduction in the recording of oligohydramnios with a 4-week interval between examinations. This study suggests that the two-weekly ultrasound surveillance program which is currently recommended for monochorionic twins should be extended to dichorionic gestations. |
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