Skip to main content
SMFM 2025 Pregnancy Meeting Main banner
Final Program


Program Book
Icon Legend
Presentation Icons
Additional registration fee required
Additional registration fee required
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording
Recording
Poster Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Back

Poster Session 4

(1185) Intertwin EFW discordance and perinatal loss in monochorionic diamniotic twins with selective fetal growth restriction

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • 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

    • Coauthor(s)

  • 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

  • BC

    Beverly G. Coleman, MD

    Professor
    Richard D. Wood, Jr Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania, United States

  • JM

    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

Objective:

To identify the association between the degree of intertwin estimated fetal weight (EFW) discordance and perinatal loss in monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR).

Study Design:

Single center retrospective review of MCDA twins diagnosed with sFGR that opted for expectant management between 2010-2021. The relationship between intertwin EFW discordance and perinatal loss was evaluated using receiver–operating characteristics (ROC) and survival analysis to identify the optimal cut-off for EFW discordance.  The 2 groups of different intertwin discordance were compared to evaluate and identify other risk factors.

Results:

A total of 212 MCDA twin pregnancies with sFGR underwent expectant management in the study period. 18 pregnancies (8.5%) were dual demise and 11 (5.2%) had demise of one fetus. Of those born alive, dual neonatal demise was seen in 5 (2.4%) pregnancies whereas neonatal demise of one twin was seen in 11 pregnancies (5.2%). Further, of the 11 pregnancies with one fetal demise, 5 (2.4%) had neonatal demise. Total perinatal loss rate was 73 fetuses/neonates (17.2%) of 424 (212 twins). The area under curve (AUC) ROC curve for intertwin EFW discordance and perinatal loss was 0.68 [95% CI 0.59-0.78] with a p-value of 0.0001 (Graph 1). A discordance of ≥ 33% was 56.82% sensitive and 68.45% specific in predicting perinatal loss. The gestational age at delivery and two survivors to discharge were significantly lower in pregnancies with a discordance of ≥ 33% (Table). Kaplan–Meier analysis showed that pregnancies with a discordance of ≥ 33% had a significantly lower survival trend with a p-value of 0.0001 and hazards ratio for risk of perinatal loss of 3.83 [95% CI 1.85-7.95] (Graph 2).

Conclusion:

Intertwin EFW discordance of ≥ 33% can be used as the optimal cut-off for prediction of perinatal loss in cases of MCDA twin with sFGR.