Validation of Fetal Medicine Foundation charts for fetal growth in twins: nationwide Danish cohort study.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2024-10-27 DOI:10.1002/uog.29125

S E Kristensen, A Wright, D Wright, K Gadsbøll, C K Ekelund, P Sandager, F S Jørgensen, E Hoseth, L Sperling, H J Zingenberg, K Sundberg, A McLennan, K H Nicolaides, O B Petersen

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引用次数: 0

Abstract

Objective: To assess the validity of the Fetal Medicine Foundation (FMF) chorionicity-specific models for fetal growth in twin pregnancy.

Methods: This was an external validation study of the FMF models using a nationwide Danish cohort of twin pregnancies. The cohort included all dichorionic (DC) and monochorionic diamniotic (MCDA) twin pregnancies with an estimated delivery date between 2008 and 2018, which satisfied the following inclusion criteria: two live fetuses at the first-trimester ultrasound scan (11-14 weeks' gestation); biometric measurements available for the calculation of estimated fetal weight (EFW) using the Hadlock-3 formula; and delivery of two liveborn infants. Validation involved assessing the distributional properties of the models and estimating the mean EFW Z-score deviations. Additionally, the models were applied to pregnancies that delivered preterm and attended non-scheduled visits (complicated pregnancies).

Results: Overall, 8542 DC and 1675 MCDA twin pregnancies met the inclusion criteria. In DC twins, 17 084 fetuses were evaluated at a total of 95 346 ultrasound scans, of which 44.5% were performed at scheduled visits in pregnancies carried to 37 + 0 weeks or later. The median number of growth scans per DC twin fetus from 20 + 0 weeks onwards was four. The model showed good agreement with the validation cohort for scheduled visits in DC twins delivered at 37 + 0 weeks or later (mean EFW Z-score, -0.14 ± 1.05). In MCDA twins, 3350 fetuses underwent 31 632 eligible ultrasound scans, of which 59.5% were performed at scheduled visits in pregnancies carried to 36 + 0 weeks or later. The median number of growth scans per MCDA twin fetus from 16 + 0 weeks onwards was 10. The model showed favorable agreement with the validation cohort for scheduled visits in MCDA twins delivered at 36 + 0 weeks or later (mean EFW Z-score, -0.09 ± 1.01). Non-scheduled visits and preterm delivery before 37 + 0 weeks for DC twins and before 36 + 0 weeks for MCDA twins corresponded with smaller weight estimates, which was consistent with the study's definition of complicated pregnancy.

Conclusions: The FMF models provide a good fit for EFW measurements in our Danish national cohort of uncomplicated twin pregnancies assessed at routine scans. Therefore, the FMF models establish robust criteria for subsequent investigations and potential clinical applications. Future research should focus on exploring the consequences of clinical implementation, particularly regarding the identification of twins that are small-for-gestational age, as they are especially susceptible to adverse perinatal outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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胎儿医学基金会图表对双胞胎胎儿发育的验证：丹麦全国性队列研究。

目的评估胎儿医学基金会（FMF）绒毛膜特异性模型对双胎妊娠胎儿生长的有效性：这是一项利用丹麦全国双胎妊娠队列对 FMF 模型进行的外部验证研究。该队列包括所有预产期在2008年至2018年之间的双绒毛膜双胎（DC）和单绒毛膜双胎（MCDA）妊娠，这些妊娠符合以下纳入标准：在第一孕期超声扫描（孕11-14周）时有两个活胎儿；生物测量数据可用于使用Hadlock-3公式计算估计胎儿体重（EFW）；并有两个活产婴儿出生。验证包括评估模型的分布特性和估计平均 EFW Z 分数偏差。此外，这些模型还适用于早产和未按计划就诊的孕妇（复杂妊娠）：共有 8542 例 DC 双胎和 1675 例 MCDA 双胎符合纳入标准。在直肠双胎中，17 084 名胎儿共接受了 95 346 次超声波扫描，其中 44.5%是在妊娠 37+0 周或更晚的孕妇接受定期检查时进行的。从 20+0 周起，每个 DC 双胎的生长扫描次数中位数为 4 次。该模型与验证队列中在37+0周或更晚分娩的直肠畸形双胞胎中进行的定期检查结果显示出良好的一致性（平均EFW Z-score，-0.14 ± 1.05）。在 MCDA 双胎中，有 3350 个胎儿接受了 31 632 次符合条件的超声扫描，其中 59.5%是在妊娠 36+0 周或更晚时进行的计划访视中进行的。从 16+0 周起，每个 MCDA 双胎的生长扫描次数中位数为 10 次。该模型与验证队列对 36+0 周或更晚分娩的 MCDA 双胎的计划访视显示出良好的一致性（平均 EFW Z-score，-0.09 ± 1.01）。非计划访视和早产（DC 双胞胎在 37+0 周之前、MCDA 双胞胎在 36+0 周之前）与较小的体重估计值相对应，这与该研究对复杂妊娠的定义一致：FMF模型很好地拟合了常规扫描评估的丹麦全国无并发症双胞胎队列中的EFW测量值。因此，FMF 模型为后续研究和潜在的临床应用建立了可靠的标准。未来的研究应侧重于探索临床应用的后果，特别是在识别小于胎龄的双胞胎方面，因为这些双胞胎特别容易出现不良围产期结局。© 2024 作者姓名妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。

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来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.