Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction

T. Van Mieghem; L. Lewi; F. Slaghekke; E. Lopriore; Y. Yinon; L. Raio; D. Baud; P. Dekoninck; N. Melamed; E. Huszti; Luming Sun; S. Shinar; Yidi Jiang; Wei Xing; Chen Jianping; Isabel Couck; Sophie Groene; Linoy Batsry; Sofia Amylidi-Mohr; Fannie Kneuss; Joske Moscou; Jon Barrett; Vagisha Pruthi; Greg Ryan

doi:10.1002/uog.24896

Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction

T. Van Mieghem^*, L. Lewi, F. Slaghekke, E. Lopriore, Y. Yinon, L. Raio, D. Baud, P. Dekoninck, N. Melamed, E. Huszti, Luming Sun, S. Shinar, Yidi Jiang, Wei Xing, Chen Jianping, Isabel Couck, Sophie Groene, Linoy Batsry, Sofia Amylidi-Mohr, Fannie KneussJoske Moscou, Jon Barrett, Vagisha Pruthi, Greg Ryan

^*Corresponding author for this work

Obstetrics & Gynecology

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Abstract

Objective: Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies.

Methods: This was an international multicenter retrospective cohort study. Type-III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10^th percentile and intertwin EFW discordance of ≥ 25% in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis.

Results: A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (n = 19 (6.2%)) or double (n = 16 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type-III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32 weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low-risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate-risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16 + 5 weeks' gestation; and a high-risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was < 16 + 5 weeks' gestation.

Conclusions: Type-III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest-risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort.

Original language	English
Pages (from-to)	756-762
Number of pages	7
Journal	Ultrasound in Obstetrics and Gynecology
Volume	59
Issue number	6
Early online date	8 Mar 2022
DOIs	https://doi.org/10.1002/uog.24896
Publication status	Published - Jun 2022

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Publisher Copyright: © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

At the end of the author listing: .... and collaborators

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Van Mieghem, T., Lewi, L., Slaghekke, F., Lopriore, E., Yinon, Y., Raio, L., Baud, D., Dekoninck, P., Melamed, N., Huszti, E., Sun, L., Shinar, S., Jiang, Y., Xing, W., Jianping, C., Couck, I., Groene, S., Batsry, L., Amylidi-Mohr, S., ... Ryan, G. (2022). Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction. Ultrasound in Obstetrics and Gynecology, 59(6), 756-762. https://doi.org/10.1002/uog.24896

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title = "Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction",

abstract = "Objective: Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies. Methods: This was an international multicenter retrospective cohort study. Type-III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10th percentile and intertwin EFW discordance of ≥ 25% in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis.Results: A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (n = 19 (6.2%)) or double (n = 16 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type-III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32 weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low-risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate-risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16 + 5 weeks' gestation; and a high-risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was < 16 + 5 weeks' gestation. Conclusions: Type-III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest-risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort.",

author = "{Van Mieghem}, T. and L. Lewi and F. Slaghekke and E. Lopriore and Y. Yinon and L. Raio and D. Baud and P. Dekoninck and N. Melamed and E. Huszti and Luming Sun and S. Shinar and Yidi Jiang and Wei Xing and Chen Jianping and Isabel Couck and Sophie Groene and Linoy Batsry and Sofia Amylidi-Mohr and Fannie Kneuss and Joske Moscou and Jon Barrett and Vagisha Pruthi and Greg Ryan",

note = "Publisher Copyright: {\textcopyright} 2022 International Society of Ultrasound in Obstetrics and Gynecology. At the end of the author listing: .... and collaborators",

year = "2022",

month = jun,

doi = "10.1002/uog.24896",

language = "English",

volume = "59",

pages = "756--762",

journal = "Ultrasound in Obstetrics and Gynecology",

issn = "0960-7692",

publisher = "John Wiley & Sons Ltd.",

number = "6",

}

Van Mieghem, T, Lewi, L, Slaghekke, F, Lopriore, E, Yinon, Y, Raio, L, Baud, D, Dekoninck, P, Melamed, N, Huszti, E, Sun, L, Shinar, S, Jiang, Y, Xing, W, Jianping, C, Couck, I, Groene, S, Batsry, L, Amylidi-Mohr, S, Kneuss, F, Moscou, J, Barrett, J, Pruthi, V & Ryan, G 2022, 'Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction', Ultrasound in Obstetrics and Gynecology, vol. 59, no. 6, pp. 756-762. https://doi.org/10.1002/uog.24896

TY - JOUR

T1 - Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction

AU - Van Mieghem, T.

AU - Lewi, L.

AU - Slaghekke, F.

AU - Lopriore, E.

AU - Yinon, Y.

AU - Raio, L.

AU - Baud, D.

AU - Dekoninck, P.

AU - Melamed, N.

AU - Huszti, E.

AU - Sun, Luming

AU - Shinar, S.

AU - Jiang, Yidi

AU - Xing, Wei

AU - Jianping, Chen

AU - Couck, Isabel

AU - Groene, Sophie

AU - Batsry, Linoy

AU - Amylidi-Mohr, Sofia

AU - Kneuss, Fannie

AU - Moscou, Joske

AU - Barrett, Jon

AU - Pruthi, Vagisha

AU - Ryan, Greg

PY - 2022/6

Y1 - 2022/6

N2 - Objective: Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies. Methods: This was an international multicenter retrospective cohort study. Type-III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10th percentile and intertwin EFW discordance of ≥ 25% in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis.Results: A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (n = 19 (6.2%)) or double (n = 16 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type-III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32 weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low-risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate-risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16 + 5 weeks' gestation; and a high-risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was < 16 + 5 weeks' gestation. Conclusions: Type-III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest-risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort.

AB - Objective: Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies. Methods: This was an international multicenter retrospective cohort study. Type-III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10th percentile and intertwin EFW discordance of ≥ 25% in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis.Results: A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (n = 19 (6.2%)) or double (n = 16 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type-III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32 weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low-risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate-risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16 + 5 weeks' gestation; and a high-risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was < 16 + 5 weeks' gestation. Conclusions: Type-III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest-risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort.

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U2 - 10.1002/uog.24896

DO - 10.1002/uog.24896

M3 - Article

C2 - 35258125

AN - SCOPUS:85131216667

VL - 59

SP - 756

EP - 762

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 6

ER -

Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction

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