First-Trimester Crown-Rump Length (CRL) and Nuchal Translucency (NT) Discordance in Monochorionic Twins: An Ominous Sign
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ORIGINAL ARTICLE
First‑Trimester Crown‑Rump Length (CRL) and Nuchal Translucency (NT) Discordance in Monochorionic Twins: An Ominous Sign or a Benign Feature? Saloni Arora1 · Smriti Prasad1 · Akshatha Sharma1 · Anita Kaul1 Received: 24 January 2020 / Accepted: 8 July 2020 © Federation of Obstetric & Gynecological Societies of India 2020
Abstract Background This study aimed to evaluate the usefulness of the first-trimester crown-rump length (CRL) and nuchal translucency (NT) discordance in monochorionic diamniotic twins (MCDA) for the prediction of complications—twin–twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR) or intrauterine fetal demise (IUFD). Methods Intertwin discordance in the CRL and NT was calculated as a percentage of the larger CRL and NT, respectively. The performance of inter twin discordance (CRL ≥ 10% and NT≥ 20%) for predicting complications was analysed using standard statistical screening test methods. Results Fifty-eight MCDA twin pregnancies were studied. Out of them, 19 (32%) pregnancies resulted in one of the complications studied (4 TTTS, 10 sFGR, 5 IUFD). CRL and NT discordance showed an increased probability of developing complications positive likelihood ratio (LR+) {95% confidence interval}: 2.05 {0.46–9.23} and 1.88 {1.03–3.45}, respectively. NT discordance showed a sensitivity of 57%. Conclusions Although discordant first-trimester CRL and NT in monochorionic twins are poor screening tools for early prediction, if positive, they increase the risk of developing complications. Keywords MCDA twins · CRL discordance · NT discordance · First-trimester screening
Introduction Monochorionic (MC) twin pregnancies are considered highrisk pregnancies because of the risk of developing unique complications like twin–twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR) or intrauterine fetal demise (IFUD) of one or both the twins, resulting in increased perinatal mortality and morbidity [1]. Mostly, Dr. Saloni Arora, MD, MRCOG, Fellowship Fetal Medicine, Consultant, Apollo Centre for Fetal Medicine, New Delhi, India. Dr. Smriti Prasad, MD, MRCOG, Fellowship Fetal Medicine, Consultant, Apollo Centre for Fetal Medicine, New Delhi, India. Dr. Akshatha Sharma, MD, MRCOG, Fellowship Fetal Medicine, Consultant, Apollo Centre for Fetal Medicine, New Delhi, India. Dr. Anita Kaul, MD, FRCOG, Diploma in Fetal Medicine, Clinical Coordinator and Head of Department, Apollo Centre for Fetal Medicine, New Delhi, India. * Anita Kaul [email protected] 1
Apollo Centre for Fetal Medicine, New Delhi, India
these complications are either attributable to unidirectional large vascular anastomoses in the placenta connecting two fetal circulations (more specific for the development of TTTS) or due to unequal sharing of placenta between the twins (resulting in more in sFGR cases). TTTS complicates around 10–15% of monochorionic pregnancies [2], resulting in hemodynamic and fluid imbalances among the fetuses, and if left untreated, results in f
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