Poster Session 4
Shelly Soni, MD
Assistant Professor, Clinical OBGYN in Surgery
Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP
Philadelphia, Pennsylvania, United States
Juliana S. Gebb, MD (she/her/hers)
Associate Professor
Richard D. Wood, Jr Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia
Philadelphia, PA, United States
Christina Paidas Teefey, MD
Assistant Professor, Clinical Obstetrics and Gynecology in Surgery
Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP
Philadelphia, Pennsylvania, United States
Edward R. Oliver, MD, PhD
Attending Radiologist, Associate Professor
Richard D. Wood, Jr Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Julie S. Moldenhauer, MD
Professor, Clinical OBGYN in Surgery
Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP
Philadelphia, Pennsylvania, United States
Nahla Khalek, MD, MPH, MSEd
Associate Professor, Clinical OBGYN in Surgery
Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at CHOP
Philadelphia, PA, United States
To evaluate a novel scoring system based on markers of placental insufficiency and fetal physiology that can assist in predicting perinatal loss in monochorionic diamniotic (MCDA) twins complicated by selective fetal growth restriction (sFGR). Single center retrospective review of MCDA twins diagnosed with sFGR that opted for expectant management between 2010-2021. Various demographic and outcome variables were compared in pregnancies with and without perinatal loss. Significant variables were analyzed in a multiple logistic regression model with backward elimination method to identify factors predictive of perinatal loss. The identified significant factors were re-run in multiple logistic regression to assess individual effect on outcomes. A score was then assigned based on the strength of the effect. The relationship between the assigned score and perinatal loss was evaluated using receiver–operating characteristics (ROC) and survival analysis to identify optimal cut-off.
Study Design:
Results:
A total of 212 MCDA twin pregnancies with sFGR underwent expectant management in the study period. Perinatal loss occurred in 44 pregnancies (20.8%). Of the significant variables from univariate analysis (Table 1); intertwin EFW discordance, and abnormal findings in growth restricted twin including low amniotic fluid, abnormal UA Dopplers and abnormal MCA Dopplers were identified as significant in the stepwise multiple logistic regression. These variables were re‐entered into a logistic regression model and a score was assigned according to the relative contribution of each variable in this model (Table 2). The area under ROC curve(AUC) for the score and perinatal loss was 0.78 [95% CI 0.7-0.85] with a p-value of 0.0001 (Graph 1). A score of ≥ 3 was 70.5% sensitive and 76.2% specific in predicting perinatal loss. Kaplan–Meier analysis showed that pregnancies with a high score (≥ 3) had a significantly lower survival trend with a p-value of < 0.0001 (Graph 2).
Conclusion:
This novel scoring system in MCDA twins with sFGR can be used to assess risk of perinatal loss that can be used to assist in counseling.
