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Antepartum Fetal Assessment

Poster Session 1

(132) Time to intervention or delivery in monochorionic diamniotic twins with abnormal screening ultrasound findings

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: This study sought to examine the natural history of monochorionic diamniotic (MCDA) twins that do not meet criteria for twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), or selective fetal growth restriction (sFGR) but have an abnormal finding during screening for these conditions. 

Study Design: This retrospective case-control study longitudinally reviewed all MCDA twins between 2018-2022 at a tertiary fetal care center. Twins with normal imaging acted as controls, and those with abnormalities on screening ultrasounds (US) were included as cases. Excluded were twins with clear diagnostic findings of TTTS, TAPS, or sFGR as well as higher-order multiples, anomalies which could affect fluid or Dopplers, and having only one US. Cases were divided into subgroups including those with polyhydramnios of one twin, oligohydramnios of one twin, sFGR with fluid discrepancy, subjective provider concern about fluid discrepancy, and middle cerebral artery (MCA) Doppler ≥ 1.5 MoM without fluid abnormalities. The primary outcome was time from an abnormal finding to laser or to delivery. Kaplan Meier (KM) curves were generated with cases censored at laser, delivery, or at last scan when delivery records were unavailable. 

Results: Of 751 gestations, 227 were excluded for clear diagnosis, 19 for fetal anomaly 10 for higher order multiples, and 44 for having only one US. Of the remaining 438, 224 with normal imaging became controls, and the remaining 214 were cases. The probability of two ongoing weeks of pregnancy without fetal intervention or delivery differed between controls and case subgroups (control, 100%; isolated polyhydramnios, 83%; isolated oligohydramnios, 77%; sFGR with fluid discrepancy, 65%; abnormal MCA, 87%; provider concern, 62%, p = 0.01). KM curves demonstrate that sFGR with fluid discrepancy and subjective provider concern were the most morbid findings; elevated MCA Doppler was the least. 

Conclusion: Families of MCDA twins with abnormal ultrasound findings can be counseled on the likelihood of ongoing uncomplicated pregnancy based on their condition.