Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jan 28, 2025; 17(1): 103111
Published online Jan 28, 2025. doi: 10.4329/wjr.v17.i1.103111
Independent risk factors for twin pregnancy adverse fetal outcomes before 28 gestational week by first trimester ultrasound screening
Hui-Ping Zhang, Li Bao, Jing-Jing Wu, Yu-Qing Zhou
Hui-Ping Zhang, Li Bao, Jing-Jing Wu, Yu-Qing Zhou, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200050, China
Author contributions: Zhang HP and Zhou YQ designed the study; Bao L and Wu JJ collected data; Bao L, Zhang HP and Zhou YQ performed the statistical analysis; Zhang HP wrote the manuscript and all the other authors edited the manuscript; all authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Shanghai, China, No. 22ZR1458200; Medical Ph.D Innovative Talent Base Project of Changning District, Shanghai, China, No. RCJD2021B09; and Key Specialty of Changning District, Shanghai, China, No. 20231004.
Institutional review board statement: The study was reviewed and approved by the Shanghai Changning Maternity and Infant Health Hospital Institutional Review Board, approval No. CNFBLLKTY-IEC-2023-023.
Informed consent statement: Written informed consent was obtained from every patient before ultrasound examination.
Conflict-of-interest statement: The authors declare that they have no conflicts of interests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data presented in this study can be obtained by contacting the corresponding author with a reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Qing Zhou, MD, Professor, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, No. 786 Yuyuan Road, Shanghai 200050, China. doczhou@qq.com
Received: November 13, 2024
Revised: December 24, 2024
Accepted: January 17, 2025
Published online: January 28, 2025
Processing time: 68 Days and 22.6 Hours
Abstract
BACKGROUND

The incidence of multiple pregnancies has increased worldwide recently and women with a twin pregnancy are at higher risk of adverse outcomes compared with women with a singleton pregnancy. It is important to understand the risk factors for adverse fetal outcomes in twin pregnancy in order to guide clinical management.

AIM

To identify the independent risk factors, including maternal personal and family medical histories and first trimester ultrasound screening findings, for adverse fetal outcomes of twin pregnancy before 28 weeks of gestation.

METHODS

The data of 126 twin pregnancies in our hospital, including pregnancy outcomes, first trimester ultrasound screening findings and maternal medical history, were retrospectively collected. Twenty-nine women with adverse outcomes were included in the abnormal group and the remaining 97 women were included in the control group.

RESULTS

Patients in the abnormal group were more likely to be monochorionic diamniotic (13/29 vs 20/97, P= 0.009), with a higher mean pulsatility index (PI, 1.57 ± 0.55 vs 1.28 ± 0.42, P = 0.003; cutoff value: 1.393) or a higher mean resistance index (0.71 ± 0.11 vs 0.65 ± 0.11, P = 0.008; cutoff value: 0.683) or early diastolic notch of bilateral uterine arteries (UtAs, 10/29 vs 15/97, P = 0.024) or with abnormal ultrasound findings (13/29 vs 2/97, P < 0.001), compared with the control group. Monochorionic diamnioticity, higher mean PI of bilateral UtAs and abnormal ultrasound findings during first trimester screening were independent risk factors for adverse fetal outcomes (P < 0.05).

CONCLUSION

First trimester ultrasound screening for twin pregnancy identifies independent risk factors and is useful for the prediction of fetal outcomes.

Keywords: Twin pregnancy; First trimester ultrasound screening; Uterine artery; Pulsatility index; Monochorionic diamniotic twin

Core Tip: Recently, the incidence of twin pregnancy has increased worldwide. Understanding the risk factors for adverse fetal outcomes in twin pregnancy would be helpful for clinical management. We retrospectively analyzed the data of 126 twin pregnancies in the first trimester, including first trimester ultrasound screening findings. Our results showed that monochorionic diamnioticity, higher mean pulsatility index of bilateral uterine arteries and abnormal ultrasound findings during first trimester screening were independent risk factors for adverse fetal outcomes. First trimester ultrasound screening in twin pregnancy is useful for predicting fetal outcomes.