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  • Title: Outcome prediction in monochorionic diamniotic twin pregnancies with moderately discordant amniotic fluid.
    Author: Van Mieghem T, Eixarch E, Gucciardo L, Done E, Gonzales I, Van Schoubroeck D, Lewi L, Gratacos E, Deprest J.
    Journal: Ultrasound Obstet Gynecol; 2011 Jan; 37(1):15-21. PubMed ID: 20737453.
    Abstract:
    OBJECTIVE: The aim of this study was to identify predictors of twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) in monochorionic diamniotic (MCDA) twin pregnancies with moderate amniotic fluid discordance (mAFD). METHODS: Monochorionic twins with mAFD (n = 45; gestational age, 15-29 weeks) were assessed for extent of fluid discordance, fetal growth discordance and fetal cardiac dysfunction, and were followed longitudinally. A prediction algorithm was constructed for TTTS and sIUGR and validated in an unrelated cohort (n = 52). RESULTS: Cardiac dysfunction could not predict TTTS or sIUGR. Twins below 20 weeks of gestation with a fluid discordance of ≥ 3.1 cm had a risk of TTTS of 85.7%. Sensitivity for TTTS was nevertheless only 55%. An intertwin weight discordance of ≥ 25% had 63% sensitivity and 76% specificity for sIUGR without TTTS. CONCLUSION: The outcome of MCDA twins with mAFD remains unpredictable, yet high-risk and low-risk subgroups for TTTS can be identified based on severity of fluid discordance and gestational age.
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