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Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis.
- Source :
-
American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2018 Nov; Vol. 219 (5), pp. 436-446. Date of Electronic Publication: 2018 May 12. - Publication Year :
- 2018
-
Abstract
- Background: Monochorionic twin pregnancies are high-risk, however at present, no screening test is available to predict which monochorionic twin pregnancy will develop complications.<br />Objective: We sought to assess ability of first-trimester pregnancy-related factors (ultrasound measurements, maternal characteristics, biomarkers) to predict complications in monochorionic twin pregnancies.<br />Data Sources: Data sources were MEDLINE, Embase, ISI Web of Science, CINAHL, the Cochrane Central Registration of Controlled Trials and Research Registers, and Google Scholar, from inception to May 12, 2017. Gray literature and bibliographies of articles were checked.<br />Study Eligibility Criteria: Studies that reported ultrasound measurements, maternal characteristics, or potential biomarkers, measured in the first trimester in monochorionic-diamniotic twin pregnancies, where the potential prognostic ability between the variable and twin-twin transfusion syndrome, growth restriction, or intrauterine fetal death could be assessed, were included.<br />Study Appraisal and Synthesis Methods: Quality assessment was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology checklist by 2 reviewers independently. For meta-analysis, odds ratios using a random effects model, or standardized mean difference were calculated. If a moderate association was found, the prognostic ability was evaluated by calculating the sensitivity and specificity. Risk of heterogeneity was reported as I <superscript>2</superscript> and publication bias was visually assessed by funnel plots and quantitatively by Egger test.<br />Results: In all, 48 studies were eligible for inclusion. Twenty meta-analyses could be performed. A moderate association was demonstrated in 3 meta-analyses, between: nuchal translucency >95th centile in one/both fetuses and twin-twin transfusion syndrome (odds ratio, 2.29 [95% confidence interval, 1.05-4.96], I <superscript>2</superscript>  = 6.6%, 4 studies, 615 pregnancies); crown-rump length discordance ≥10% and twin-twin transfusion syndrome (odds ratio, 2.43 [95% confidence interval, 1.13-5.21], I <superscript>2</superscript>  = 14.1%, 3 studies, 708 pregnancies); and maternal ethnicity and twin-twin transfusion syndrome (odds ratio, 2.12 [95% confidence interval, 1.17-3.83], I <superscript>2</superscript>  = 0.0%, 5 studies, 467 pregnancies), but none demonstrated a prognostic ability for any outcome under investigation.<br />Conclusion: It is not currently possible to predict adverse outcomes in monochorionic twin pregnancies. We have revealed a lack of research investigating first-trimester biomarkers in monochorionic twin pregnancies. Different assessment methods and definitions of each variable and outcome were an issue and this highlights the need for a large cohort study to evaluate these factors.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Subjects :
- Crown-Rump Length
Diseases in Twins diagnostic imaging
Diseases in Twins epidemiology
Female
Fetal Death
Fetal Growth Retardation
Fetofetal Transfusion
Gestational Age
Humans
MEDLINE
Nuchal Translucency Measurement
Odds Ratio
Pregnancy
Pregnancy Trimester, First
Prognosis
Twins, Monozygotic
Ultrasonography, Prenatal
Diseases in Twins embryology
Pregnancy Outcome
Pregnancy, Twin
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6868
- Volume :
- 219
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American journal of obstetrics and gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 29763608
- Full Text :
- https://doi.org/10.1016/j.ajog.2018.05.008