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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Greenough, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Ogata, Edward / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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The source of error in the estimation of intertwin birth weight discordance

Maria Augusta Reberdao1 / Luisa Martins1 / Mariana Torgal1 / Rui Viana1 / Tatiana Seminova1 / Ester Casal1 / Manuel Hermida1 / Isaac Blickstein2

1Prenatal Diagnosis Center, Hospital Garcia de Orta, Almada, Portugal

2Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel

Corresponding author: Isaac Blickstein, MD Department of Obstetrics and Gynecology Kaplan Medical Center 76100 Rehovot Israel Tel.: +972-545-201789 Fax: +972-89411944

Citation Information: Journal of Perinatal Medicine. Volume 38, Issue 6, Pages 671–674, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/jpm.2010.104, August 2010

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Objective: To assess the accuracy of paired estimated fetal weights (EFWs) to predict three levels of twin birth weight discordance (>15%, >20% and >25%).

Method: A cohort of twin pairs underwent ultrasound examinations within 2 weeks from birth. We calculated the frequency of under- and overestimation of the actual birth weight (< or >10%, respectively) in the entire cohort as well in the subset of mono- and dichorionic pairs.

Results: Discordance was largely underestimated (observed 10.4±0.8% compared to actual 19.2±1.1%, P=0.001) because the larger twin was more frequently underestimated [30.6 vs. 17.7%, odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1, 3.9 in the entire cohort, and 34.2 vs. 13.1%, OR 3.4, 95% CI 1.4, 8.4 in the dichorionic pairs]. Overall, the specificity for detecting the three levels of discordance was adequate (91.5–94.2%) but the sensitivity was poor (11.1–17.8%) and tended to decrease with increasing discordance level.

Conclusion: The poor ability of paired EFWs to diagnose birth weight discordance results from underestimation of the larger twin.

Keywords: Birth weight discordance; chorionicity; estimated fetal weight; twins; ultrasound

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