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Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study

BACKGROUND: Seeking an optimal time point for ultrasound examination is important for the diagnosis of late selective intrauterine growth restriction (sIUGR) at birth in monochorionic diamniotic (MCDA) twin pregnancies. We aimed to assess the role of ultrasound characteristics at 19–24 weeks as pred...

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Autores principales: Zhu, Yin-Di, Wang, Ming-Yue, Pan, Mei-Fang, Bian, Jin-Yan, Chen, You-Guo, Gu, Xin-Xian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372677/
https://www.ncbi.nlm.nih.gov/pubmed/35965827
http://dx.doi.org/10.21037/atm-22-3089
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author Zhu, Yin-Di
Wang, Ming-Yue
Pan, Mei-Fang
Bian, Jin-Yan
Chen, You-Guo
Gu, Xin-Xian
author_facet Zhu, Yin-Di
Wang, Ming-Yue
Pan, Mei-Fang
Bian, Jin-Yan
Chen, You-Guo
Gu, Xin-Xian
author_sort Zhu, Yin-Di
collection PubMed
description BACKGROUND: Seeking an optimal time point for ultrasound examination is important for the diagnosis of late selective intrauterine growth restriction (sIUGR) at birth in monochorionic diamniotic (MCDA) twin pregnancies. We aimed to assess the role of ultrasound characteristics at 19–24 weeks as predictive tools for late sIUGR at birth in MCDA twin pregnancies. METHODS: We retrospectively recruited 32 sIUGR and 56 normal patients with MCDA twin pregnancies. Ultrasound indexes of these included subjects at 19–24 weeks, including the middle cerebral artery peak systolic velocity (MCA-PSV), umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) were assessed. Receiver operating characteristic (ROC) curves were used to ascertain the predictive value of ultrasound characteristics discrepancy for such complications, and the relationship between the ultrasound characteristics and sIUGR was assessed by a logistic regression analysis. RESULTS: Differences were found in the MCA-PI, UA-PI, and CPR discordances between the normal MCDA and sIUGR subjects. CPR discordance was the most effective characteristic for predicting sIUGR [area under the ROC curve (AUC) =0.883; 95% CI: 0.795–0.948], followed by UA-PI discordance (AUC =0.772; 95% CI: 0.685–0.829), and MCA-PI discordance (AUC =0.746; 95% CI: 0.681–0.823), respectively. Additionally, the optimal cutoff value of CPR discordance was 21.65, and the corresponding sensitivity and specificity were 0.750 and 0.929, respectively. The correlation analysis revealed that gestational age (GA) at ultrasound scan but not at delivery was significantly correlated with the MCA-PSV (r=0.55, P<0.01), UA-PI (r=0.55, P<0.01), MCA-PI (r=0.49, P<0.01), and CPR (r=0.55, P<0.01) in sIUGR, while GA at both ultrasound scan and birth was significantly correlated with MCA-PSV (r=0.65, P<0.01), UA-PI (r=0.49, P<0.01), MCA-PI (r=0.48, P<0.01), and CPR (r=0.63, P<0.01) in normal MCDA. CONCLUSIONS: Increased MCA-PI, UA-PI, and CPR discordances were found in fetuses with sIUGR. CPR discordance could serve as a predictive index for sIUGR. An early ultrasound examination may be more accurate than biochemical modality for sIUGR prediction.
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spelling pubmed-93726772022-08-13 Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study Zhu, Yin-Di Wang, Ming-Yue Pan, Mei-Fang Bian, Jin-Yan Chen, You-Guo Gu, Xin-Xian Ann Transl Med Original Article BACKGROUND: Seeking an optimal time point for ultrasound examination is important for the diagnosis of late selective intrauterine growth restriction (sIUGR) at birth in monochorionic diamniotic (MCDA) twin pregnancies. We aimed to assess the role of ultrasound characteristics at 19–24 weeks as predictive tools for late sIUGR at birth in MCDA twin pregnancies. METHODS: We retrospectively recruited 32 sIUGR and 56 normal patients with MCDA twin pregnancies. Ultrasound indexes of these included subjects at 19–24 weeks, including the middle cerebral artery peak systolic velocity (MCA-PSV), umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) were assessed. Receiver operating characteristic (ROC) curves were used to ascertain the predictive value of ultrasound characteristics discrepancy for such complications, and the relationship between the ultrasound characteristics and sIUGR was assessed by a logistic regression analysis. RESULTS: Differences were found in the MCA-PI, UA-PI, and CPR discordances between the normal MCDA and sIUGR subjects. CPR discordance was the most effective characteristic for predicting sIUGR [area under the ROC curve (AUC) =0.883; 95% CI: 0.795–0.948], followed by UA-PI discordance (AUC =0.772; 95% CI: 0.685–0.829), and MCA-PI discordance (AUC =0.746; 95% CI: 0.681–0.823), respectively. Additionally, the optimal cutoff value of CPR discordance was 21.65, and the corresponding sensitivity and specificity were 0.750 and 0.929, respectively. The correlation analysis revealed that gestational age (GA) at ultrasound scan but not at delivery was significantly correlated with the MCA-PSV (r=0.55, P<0.01), UA-PI (r=0.55, P<0.01), MCA-PI (r=0.49, P<0.01), and CPR (r=0.55, P<0.01) in sIUGR, while GA at both ultrasound scan and birth was significantly correlated with MCA-PSV (r=0.65, P<0.01), UA-PI (r=0.49, P<0.01), MCA-PI (r=0.48, P<0.01), and CPR (r=0.63, P<0.01) in normal MCDA. CONCLUSIONS: Increased MCA-PI, UA-PI, and CPR discordances were found in fetuses with sIUGR. CPR discordance could serve as a predictive index for sIUGR. An early ultrasound examination may be more accurate than biochemical modality for sIUGR prediction. AME Publishing Company 2022-07 /pmc/articles/PMC9372677/ /pubmed/35965827 http://dx.doi.org/10.21037/atm-22-3089 Text en 2022 Annals of Translational Medicine. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Zhu, Yin-Di
Wang, Ming-Yue
Pan, Mei-Fang
Bian, Jin-Yan
Chen, You-Guo
Gu, Xin-Xian
Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
title Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
title_full Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
title_fullStr Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
title_full_unstemmed Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
title_short Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
title_sort retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9372677/
https://www.ncbi.nlm.nih.gov/pubmed/35965827
http://dx.doi.org/10.21037/atm-22-3089
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