RESUMO
Objective: To investigate the difference of intertwin estimated fetal weight (EFW) in normal dichorionic pregnancy and the impact factors. Methods: Prenatal ultrasonic parameters of 550 normal dichorionic twins (1 100 fetuses) were retrospectively analyzed. Fetal weight was estimated based on head circumference, abdominal circumference, biparietal diameter and femur length. The growth discordance ratio of EFW was calculated between the two fetuses. The correlation between the gestational weeks and the discordance ratios was assessed. In addition, whether the gender difference and different fertilization way could be impact factors of EFW discordance was evaluated. Results: No obvious correlation was observed between EFW discordance ratio and gestation age. EFW discordance ratio was skew distribution, with median of 6.65%, interquartile range of 8.92% and the 95th percentiles of 20.81%. There was no statistical significant difference of EFW discordance ratio between gender-identical group and gender-specific group, nor between two groups with different fertilization way (both P>0.05). Conclusion: Ultrasound is valuable to obtain EFW in dichorionic twins. EFW discordance ratio can be used as a relatively date-independent index in evaluation of the growth of dichorionic twins.
RESUMO
The aim of this study was to compare different fetal growth curves in twin pregnancies with severe placental insufficiency. A retrospective cross-sectional analysis of 47 twin pregnancies with absent or reverse end diastolic flow in the umbilical artery of one fetus was performed. Pregnancies with major fetal abnormalities, twin-twin transfusion or three or more fetuses were not included. The estimated fetal weight zeta-scores were calculated for both fetuses (abnormal Doppler and co-twin) according to the following criteria: Hadlock, Liao and Araújo. The abdominal circumference zeta-scores were calculated according to Hadlock, Liao, Araújo, Ong and Stirrup. The mean estimates of the zeta-score values were calculated using generalized estimating equation regression analysis. The mean gestational age at inclusion was 27.4±4.7 weeks. The fetal sex and the interaction Doppler findings × criteria correlated significantly with the zeta-score values (p <0.001 for both variables). The estimated fetal weight mean zeta-scores (standard error) according to each criteria were as follows: Hadlock - abnormal Doppler: -2.98 (0.18), co-twin: -1.16 (0.15); Liao - abnormal Doppler: -2.89 (0.24), co-twin: -0.58 (0.19); and Araújo - abnormal Doppler: -3.05 (0.29), co-twin: -0.75 (0.18). Values for abdominal circumference were as follows: Hadlock - abnormal Doppler: -3.14 (0.26), co-twin: -1.13 (0.19); Liao - abnormal Doppler: -2.63 (0.27), co-twin: -0.42 (0.19); Araújo - abnormal Doppler: -2.44 (0.22), co-twin: -0.71 (0.14); Ong - abnormal Doppler: -3.36 (0.34), co-twin: -1.48 (0.23); and Stirrup AD -- -2.36 (0.14), co-twin: -1.18 (0.10). Sex- and plurality-specific charts should be used in the evaluation of fetal growth in twin pregnancies with placental insufficiency.