Risk factors associated with stillbirth and adverse perinatal outcomes in dichorionic twin pregnancies complicated by selective fetal growth restriction: a cohort study

Kalafat E., Liu B., Barratt I., Bhate R., Papageorghiou A., Khalil A.

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, vol.131, no.2, pp.189-198, 2024 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 131 Issue: 2
  • Publication Date: 2024
  • Doi Number: 10.1111/1471-0528.17564
  • Journal Name: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Public Affairs Index
  • Page Numbers: pp.189-198
  • Keywords: adverse perinatal outcome, discordance, fetal death, fetal growth restriction, intrauterine demise, middle cerebral artery, multifetal gestation, multiple pregnancy, neonatal, stillbirth, twin, umbilical artery, WEIGHT, HEAD
  • Middle East Technical University Affiliated: No

Abstract

Objective: The main aim of this study was to investigate the perinatal outcomes of dichorionic twin pregnancies complicated by selective fetal growth restriction (sFGR).Design: Retrospective cohort study.Setting: Tertiary reference centre. Population: Dichorionic twin pregnancies complicated by sFGR between 2000 and 2019 in St George's University Hospital.Methods: Regression analyses were performed using generalised linear models and mixed-effects generalised linear models where appropriate to account for pregnancy level dependency in variables. Time to event analyses were performed with mixed effects Cox regression models. Main outcome measures: Stillbirth, neonatal death or neonatal unit admission with morbidity in one or both twins.Results: A total of 102 (of 2431 dichorionic twin pregnancies) pregnancies complicated by sFGR were included in the study. The Cochrane- Armitage test revealed a significant trend for increased adverse perinatal outcome rates with more severe forms of umbilical artery flow impedance, i.e. reversed, absent, positive with resistant flow and positive flow without resistance. A multivariable model including maternal and conception characteristics had poor predictive accuracy for stillbirth (area under the curve: 0.68, 95% confidence interval [CI] 0.55- 0.81) and composite adverse perinatal outcomes (area under the curve: 0.58, 95% CI 0.47- 0.70). When umbilical artery Doppler parameters were added to the models, the area under the curve values improved to 0.95 (95% CI 0.89- 0.99) and 0.83 (95% CI 0.73- 0.92) for stillbirth and composite adverse perinatal outcomes, respectively.Conclusion: In dichorionic twin pregnancies complicated by sFGR, the umbilical artery Z- scores were associated with both intrauterine death and adverse perinatal outcomes.