Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Mar 9;3(3):CD012553.
doi: 10.1002/14651858.CD012553.pub2.

Ultrasound for diagnosis of birth weight discordance in twin pregnancies

Shayesteh Jahanfar  1 , Jacqueline J Ho  2 , Sharifah Halimah Jaafar  3 , Iosief Abraha  4 , Mohaddesseh Noura  5 , Cassandra R Ross  6 , Mohan Pammi  7
Affiliations
Meta-Analysis

Ultrasound for diagnosis of birth weight discordance in twin pregnancies

Shayesteh Jahanfar et al. Cochrane Database Syst Rev. .

Abstract

Background: There is a need to standardize monitoring in obstetric research of twin pregnancies. Identification of birth weight discordance (BWD), defined as a difference in the birth weights of twins, is a well-documented phenomenon in twin pregnancies. Ultrasound for the diagnosis of BWD informs complex decision making including whether to intervene medically (via laser photo coagulation) or deliver the twins to avoid fetal morbidities or even death. The question is, how accurate is this measurement?

Objectives: To determine the diagnostic accuracy (sensitivity and specificity) of ultrasound estimated fetal weight discordance (EFWD) of 20% and 25% using different estimated biometric ultrasound measurements compared with the actual BWD as the reference standard in twin pregnancies.

Search methods: The search for this review was performed on 15 March 2019. We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), seven other databases, conference proceedings, reference lists and contacted experts. There were no language or date restrictions applied to the electronic searches, and no methodological filters to maximize sensitivity.

Selection criteria: We selected cohort-type studies with delayed verification that evaluated the accuracy of biometric measurements at ultrasound scanning of twin pregnancies that had been proposed for the diagnosis of estimated BWD, compared to BWD measurements after birth as a reference standard. In addition, we only selected studies that considered twin pregnancies and applied a reference standard for EFWD for the target condition of BWD.

Data collection and analysis: We screened all titles generated by electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility, and extracted data to create 2 × 2 tables. Two review authors independently performed quality assessment using the QUADAS-2 tool. We excluded studies that did not report data in sufficient detail to construct 2 × 2 tables, and where this information was not available from the primary investigators. We assessed the certainty of the evidence using the GRADE approach.

Main results: We included 39 eligible studies with a median study sample size of 140. In terms of risk of bias, there were many unclear statements regarding patient selection, index test and use of proper reference standard. Twenty-one studies (53%) were of methodological concern due to flow and timing. In terms of applicability, most studies were of low concern. Ultrasound for diagnosis of BWD in twin pregnancies at 20% cut-off Twenty-two studies provided data for a BWD of 20% and the summary estimate of sensitivity was 0.51 (95% CI 0.42 to 0.60), and the summary estimate of specificity was 0.91 (95% CI 0.89 to 0.93) (8005 twin pregnancies; very low-certainty evidence). Ultrasound for diagnosis of BWD in twin pregnancies at 25% cut-off Eighteen studies provided data using a BWD discordance of 25%. The summary estimate of sensitivity was 0.46 (95% CI 0.26 to 0.66), and the summary estimate of specificity was 0.93 (95% CI 0.89 to 0.96) (6471 twin pregnancies; very low-certainty evidence). Subgroup analyses were possible for both BWD of 20% and 25%. The diagnostic accuracy did not differ substantially between estimation by abdominal circumference and femur length but femur length had a trend towards higher sensitivity and specificity. Subgroup analyses were not possible by sex of twins, chorionicity or gestational age due to insufficient data.

Authors' conclusions: Very low-certainty evidence suggests that EFWD identified by ultrasound has low sensitivity but good specificity in detecting BWD in twin pregnancies. There is uncertain diagnostic value of EFWD; this review suggests there is insufficient evidence to support this index as the sole measure for clinical decision making to evaluate the prognosis of twins with growth discordance. The diagnostic accuracy of other measures including amniotic fluid index and umbilical artery Doppler resistive indices in combination with ultrasound for clinical intervention requires evaluation. Future well-designed studies could also evaluate the impact of chorionicity, sex and gestational age in the diagnostic accuracy of ultrasound for EFWD.

PubMed Disclaimer

Conflict of interest statement

SJ: none.

JH: none.

SH: none.

IA: none.

MN: none.

CR: none.

MP: none.

Figures

1
1
PRISMA flow diagram outlining the study selection process.
2
2
QUADAS‐2 risk of bias and applicability concerns graph including review authors' judgements about each domain presented as percentages across included studies.
3
3
QUADAS‐2 risk of bias and applicability concerns summary including review authors’ judgements about each domain for each included study.
4
4
A forest plot representing study level sensitivities and specificities that used an estimated fetal weight discordance (EFWD) of 20%.
5
5
Summary receiver operating characteristic plot of studies assessing the accuracy of ultrasound based on an estimated fetal weight discordance (EFWD) of 20%. Each study is represented as an ellipse with size of the ellipse adjusted to the sample size of the study. The filled circle represents the summary point indicating summary sensitivity and specificity of the meta‐analytic estimate. Dotted closed line represents 95% confidence region and the dashed line represents the 95% prediction region around the summary point.
6
6
A forest plot representing sensitivities and specificities of the studies that used ultrasound abdominal circumference to detect estimated fetal weight discordance (EFWD) of 20%. FN: false negative; FP: false positive; TN: true negative; TP: true positive.
7
7
A forest plot representing sensitivities and specificities of the studies that used femoral length by ultrasound to detect estimated fetal weight discordance (EFWD) of 20%. FN: false negative; FP: false positive; TN: true negative; TP: true positive.
8
8
A forest plot representing sensitivities and specificities of all the studies that used an estimated fetal weight discordance (EFWD) of 25%. FN: false negative; FP: false positive; TN: true negative; TP: true positive.
9
9
Summary receiver operating characteristic plot of studies assessing the accuracy of ultrasound based on an estimated fetal weight discordance (EFWD) of 25%. Each study is represented as an ellipse with size of the ellipse adjusted to the sample size of the study. The filled circle represents the summary point indicating summary sensitivity and specificity of the meta‐analytic estimate. Dotted closed line represents 95% confidence region and the dashed line represents the 95% prediction region around the summary point.
10
10
A forest plot representing sensitivities and specificities of the studies that used ultrasound abdominal circumference to detect estimated fetal weight discordance (EFWD) of 25%. FN: false negative; FP: false positive; TN: true negative; TP: true positive.
11
11
A forest plot representing sensitivities and specificities of the studies that used ultrasound femoral length to detect estimated fetal weight discordance (EFWD) of 25%. FN: false negative; FP: false positive; TN: true negative; TP: true positive.
1
1. Test
Cut‐off 20%
2
2. Test
20% abdominal circumference
3
3. Test
20% femur length
4
4. Test
Cut‐off 25%
5
5. Test
25% abdominal circumference
6
6. Test
25% femur length
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012553

References

References to studies included in this review

Bimson 2012 {unpublished data only}
    1. Bimson B, Schwartz RA, Morrissey M, Lust B, Brustman L. How accurate is ultrasound in predicting birth weight discordance in twin gestations? Reproductive Sciences. 59th Annual Scientific Meeting of the Society for Gynecologic Investigation, San Diego, CA, United States 2012;19(3 Suppl 1):146A.
Bimson 2014a {published data only}
    1. Bimson BE, Brustman L, Murphy E, Foroutan J, Herrera K, Rosenn B. Does ultrasound accurately predict growth discordance in dichorionic diamniotic twins? Reproductive Sciences. 61st Annual Scientific Meeting of the Society for Gynecologic Investigation, Florence, Italy 2014;21(3 Suppl):169A-70A.
Bimson 2014b {published data only}
    1. Bimson BE, Brustman L, Murphy E, Herrera K, Foroutan J, Rosenn B. Using ultrasound, what best predicts pathologic discordance in diamniotic dichorionic twins? Reproductive Sciences. 61st Annual Scientific Meeting of the Society for Gynecologic Investigation, Florence, Italy 2014;21(3):169A.
Blickstein 1989 {published data only}
    1. Blickstein I, Friedman A, Caspi B, Lancet M. Ultrasonic prediction of growth discordancy by intertwin difference in abdominal circumference. International Journal of Gynaecology and Obstetrics 1989;29(2):121-4. - PubMed
Blickstein 1996 {published data only}
    1. Blickstein I, Manor M, Levi R, Goldchmit R. Is intertwin birth weight discordance predictable? Gynecologic and Obstetric Investigation 1996;42(2):105-8. - PubMed
Caravello 1997 {published data only}
    1. Caravello JW, Chauhan SP, Morrison JC, Magann EF, Martin JN Jr, Devoe LD. Sonographic examination does not predict twin growth discordance accurately. Obstetrics and Gynecology 1997;89(4):529-33. - PubMed
Chamberlain 1991 {published data only}
    1. Chamberlain P, Murphy M, Comerford FR. How accurate is antenatal sonographic identification of discordant birthweight in twins? European Journal of Obstetrics, Gynecology, and Reproductive Biology 1991;40(2):91-6. - PubMed
Chang 2006 {published data only}
    1. Chang YL, Chang TC, Chang SD, Cheng PJ, Chao AS, Hsieh PC, et al. Sonographic prediction of significant intertwin birth weight discordance. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2006;127(1):35-40. - PubMed
Chauhan 1995 {published data only}
    1. Chauhan SP, Washburne JF, Roberts WE, Magann EF, Morrison JC, Martin JN. Estimates of birth-weight among twins by the use of femur length alone. Journal of Maternal-fetal Investigation 1995;5(2):113-6.
Crane 1980 {published data only}
    1. Crane JP, Tomich PG, Kopta M. Ultrasonic growth patterns in normal and discordant twins. Obstetrics and Gynecology 1980;55(6):678-83. - PubMed
D'Antonio 2013a {published data only}
    1. D'Antonio F, Khalil A, Dias T, Thilaganathan B. Weight discordance and perinatal mortality in twins: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) multiple pregnancy cohort. Ultrasound in Obstetrics & Gynecology 2013;41(6):643-8. - PubMed
D'Antonio 2014 {published data only}
    1. D'Antonio F, Khalil A, Thilaganathan B. Second-trimester discordance and adverse perinatal outcome in twins: the STORK multiple pregnancy cohort. BJOG 2014;121(4):422-9. - PubMed
Danon 2008 {published data only}
    1. Danon D, Melamed N, Bardin R, Meizner I. Accuracy of ultrasonographic fetal weight estimation in twin pregnancies. Obstetrics and Gynecology 2008;112(4):759-64. - PubMed
Diaz‐Garcia 2010 {published data only}
    1. Diaz-Garcia C, Bernard JP, Ville Y, Salomon LJ. Validity of sonographic prediction of fetal weight and weight discordance in twin pregnancies. Prenatal Diagnosis 2010;30(4):361-7. - PubMed
Fox 2011 {published data only}
    1. Fox NS, Saltzman DH, Schwartz R, Roman AS, Klauser CK, Rebarber A. Second-trimester estimated fetal weight and discordance in twin pregnancies. Journal of Ultrasound in Medicine 2011;30(8):1095-101. - PubMed
Hehir 2017 {published data only}
    1. Hehir MP, Breathnach FM, Hogan JL, McAuliffe FM, Geary MP, Daly S, et al. Prenatal prediction of significant intertwin birthweight discordance using standard second and third trimester sonographic parameters. Acta Obstetricia et Gynecologica Scandinavica 2017;96(4):472-8. - PubMed
Hill 1994 {published data only}
    1. Hill LM, Guzick D, Chenevey P, Boyles D, Nedzesky P. The sonographic assessment of twin growth discordancy. ACOG Current Journal Review 1994;2(8):20. - PubMed
Hoopmann 2011 {published data only}
    1. Hoopmann M, Kagan KO, Yazdi B, Grischke EM, Abele H. Prediction of birth weight discordance in twin pregnancies by second-and third-trimester ultrasound. Fetal Diagnosis and Therapy 2011;30(1):29-34. - PubMed
Jensen 1995 {published data only}
    1. Jensen OH, Jenssen H. Prediction of fetal weights in twins. Acta Obstetricia et Gynecologica Scandinavica 1995;74(3):177-80. - PubMed
Johansen 2014 {published data only}
    1. Johansen ML, Oldenburg A, Rosthøj S, Cohn Maxild J, Rode L, Tabor A. Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies? Ultrasound in Obstetrics & Gynecology 2014;43(3):277-83. - PubMed
Kalish 2003 {published data only}
    1. Kalish RB, Chasen ST, Gupta M, Sharma G, Perni SC, Chervenak FA. First trimester prediction of growth discordance in twin gestations. American Journal of Obstetrics & Gynecology 2003;189(3):706-9. - PubMed
Kim 2015 {published data only}
    1. Kim JH, Sung JH, Kim JY, Chang KH, Choi SJ, Oh SY, et al. Pregnancy outcome of isolated cases of inter-twin fetal weight discordance estimated by antenatal ultrasound. International Journal of Gynecology & Obstetrics 2015;131(S5):E461.
Klam 2005 {published data only}
    1. Klam SL, Rinfret D, Leduc L. Prediction of growth discordance in twins with the use of abdominal circumference ratios. American Journal of Obstetrics & Gynecology 2005;192(1):247-51. - PubMed
Machado 2007 {published data only}
    1. Machado RC, Brizot ML, Liao AW, Cabar FR, Zugaib M. Prenatal sonographic prediction of twin growth discordance. Twin Research and Human Genetics 2007;10(1):198-201. - PubMed
MacLean 1992 {published data only}
    1. MacLean M, Mathers A, Walker JJ, Cameron AD, Howat R. The ultrasonic assessment of discordant growth in twin pregnancies. Ultrasound in Obstetrics & Gynecology 1992;2(1):30-4. - PubMed
Murray 2014 {published data only}
    1. Murray A, Breathnach F, McAuliffe F, Geary M, Daly S, Higgins J, et al. 187: Prediction of significant birth weight discordance in twin pregnancies with second and third trimester ultrasound. American Journal of Obstetrics & Gynecology 2014;210(1):S104.
Nakayama 2014 {published data only}
    1. Nakayama S, Ishii K, Kawaguchi H, Yamamoto R, Murata M, Hayashi S, et al. Perinatal complications of monochorionic diamniotic twin gestations with discordant crown-rump length determined at mid-first trimester. Journal of Obstetrics and Gynaecology Research 2014;40(2):418-23. - PubMed
O'Connor 2013 {published data only}
    1. O'Connor C, McAuliffe FM, Breathnach FM, Geary M, Daly S, Higgins JR, et al. Prediction of outcome in twin pregnancy with first and early second trimester ultrasound. Journal of Maternal-fetal & Neonatal Medicine 2013;26(10):1030-5. - PubMed
Reberdao 2010 {published data only}
    1. Reberdao MA, Martins L, Torgal M, Viana R, Seminova T, Casal E, et al. The source of error in the estimation of intertwin birth weight discordance. Journal of Perinatal Medicine 2010;38(6):671-4. - PubMed
Sayegh 1993 {published data only}
    1. Sayegh SK, Warsof SL. Ultrasonic prediction of discordant growth in twin pregnancies. Fetal Diagnosis and Therapy 1993;8(4):241-6. - PubMed
Secher 1985 {published data only}
    1. Secher NJ, Kaern J, Hansen PK. Intrauterine growth in twin pregnancies: prediction of fetal growth retardation. Obstetrics and Gynecology 1985;66(1):63-8. - PubMed
Shahshahan 2011 {published data only}
    1. Shahshahan Z, Hashemi M. Crown-rump length discordance in twins in the first trimester and its correlation with perinatal complications. Journal of Research in Medical Sciences 2011;16(9):1224. - PMC - PubMed
Simoes 2011 {published data only}
    1. Simoes T, Julio C, Cordeiro A, Cohen A, Silva A, Blickstein I. Abdominal circumference ratio for the diagnosis of intertwin birth weight discordance. Journal of Perinatal Medicine 2011;39(1):43-6. - PubMed
Storlazzi 1987 {published data only}
    1. Storlazzi E, Vintzileos AM, Campbell WA, Nochimson DJ, Weinbaum PJ. Ultrasonic diagnosis of discordant fetal growth in twin gestations. Obstetrics and Gynecology 1987;69(3 Pt 1):363-7. - PubMed
van de Waarsenburg 2015 {published data only}
    1. de Waarsenburg MK, Hack KE, Rijpma RJ, Mulder EJ, Pistorius L, Derks JB. Ultrasonographic prediction of birth weight discordance in twin pregnancies. Prenatal Diagnosis 2015;35(9):906-12. - PubMed
van Mieghem 2009 {published data only}
    1. Mieghem T, Deprest J, Klaritsch P, Gucciardo L, Done E, Verhaeghe J, et al. Ultrasound prediction of intertwin birth weight discordance in monochorionic diamniotic twin pregnancies. Prenatal Diagnosis 2009;29(3):240-4. - PubMed
Watson 1991 {published data only}
    1. Watson WJ, Valea FA, Seeds JW. Sonographic evaluation of growth discordance and chorionicity in twin gestation. American Journal of Perinatology 1991;8(05):342-4. - PubMed
Zipori 2016 {published data only}
    1. Zipori Y, Reidy K, Gilchrist T, Doyle LW, Umstad MP. The outcome of monochorionic diamniotic twins discordant at 11 to 13+ 6 weeks' gestation. Twin Research and Human Genetics 2016;19(6):692-6. - PubMed
Zuckerwise 2015 {published data only}
    1. Zuckerwise L, Nayeri U, Abdel-Razeq S, Copel J, Bahtiyar MO. Doppler abnormalities in monochorionic diamniotic twin pregnancies with discordant growth. Journal of Perinatology 2015;35(6):387. - PubMed

References to studies excluded from this review

Allaf 2014 {published data only}
    1. Allaf MB, Campbell WA, Vintzileos AM, Haeri S, Javadian P, Shamshirsaz AA, et al. Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies? Journal of Ultrasound in Medicine 2014;33(9):1573-8. - PubMed
Banks 2008 {published data only}
    1. Banks CL, Nelson SM, Owen P. First and third trimester ultrasound in the prediction of birthweight discordance in dichorionic twins. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2008;138(1):34-8. - PubMed
Ben‐Ami 2015 {published data only}
    1. Ben-Ami I, Daniel-Spiegel E, Battino S, Melcer Y, Floeck A, Geipel A, et al. The association of crown rump length discrepancy with birthweight discordance in spontaneous versus IVF monochorionic twins: a multicenter study. Prenatal Diagnosis 2015;35(9):864-9. - PubMed
Bora 2009 {published data only}
    1. Bora SA, Bourne T, Bottomley C, Kirk E, Papageorghiou AT. Twin growth discrepancy in early pregnancy. Ultrasound in Obstetrics & Gynecology 2009;34(1):38-42. - PubMed
Brown 1987 {published data only}
    1. Brown CE, Guzick DS, Leveno KJ, Santos-Ramos R, Whalley PJ. Prediction of discordant twins using ultrasound measurement of biparietal diameter and abdominal perimeter. Obstetrics and Gynecology 1987;70(5):677-81. - PubMed
Chauhan 1996 {published data only}
    1. Chauhan SP, Cowan BD, Brost BD, Washburne JF, Magann EF, Morrison JC. Estimating birth weight in twins. Comparison of eight sonographic models. Journal of Reproductive Medicine 1996;41(6):403-8. - PubMed
Chauhan 2004 {published data only}
    1. Chauhan SP, Shields D, Parker D, Sanderson M, Scardo JA, Magann EF. Detecting fetal growth restriction or discordant growth in twin gestations stratified by placental chorionicity. Journal of Reproductive Medicine 2004;49(4):279-84. - PubMed
D'Antonio 2013b {published data only}
    1. D'Antonio F, Khalil A, Mantovani E, Thilaganathan B. Embryonic growth discordance and early fetal loss: the STORK multiple pregnancy cohort and systematic review. Human Reproduction 2013;28(10):2621-7. - PubMed
Esinler 2017 {published data only}
    1. Esinler D, Aldemir OB, Alici Davutoglu E, Karahanoglu E, Salihoglu KN, Kuzu E, et al. A new mathematical formula to predict the foetal weight in twin pregnancies: a comparison of it with 19 different formulas. Journal of Obstetrics and Gynaecology 2017;37(1):53-7. - PubMed
Fajardo‐Expósito 2011 {published data only}
    1. Fajardo-Expósito MA, Hervías B, González FB, Melero-Jiménez V, Quintero-Prado R, Facio-Fernández MC, et al. First trimester fetal head and trunk volume predict growth disturbance in twin pregnancy. Prenatal Diagnosis 2011;31(6):543-7. - PubMed
Gaziano 1998 {published data only}
    1. Gaziano E, Gaziano C, Brandt D. Doppler velocimetry determined redistribution of fetal blood flow: correlation with growth restriction in diamniotic monochorionic and dizygotic twins. American Journal of Obstetrics & Gynecology 1998;178(6):1359-67. - PubMed
Harper 2012a {published data only}
    1. Harper L, Roehl K, Odibo A, Cahill A. 359: Crown-rump length discordance and adverse pregnancy outcomes in dichorionic twins. American Journal of Obstetrics and Gynecology 2012;206(1):S168-9.
Harper 2012b {published data only}
    1. Harper L, Weis M, Odibo A, Roehl K, Macones G, Cahill A. 137: Are normally grown twin pregnancies with birth weight discordance at risk for adverse outcomes? American Journal of Obstetrics and Gynecology 2012;206(1):S73.
Harper 2012c {published data only}
    1. Harper LM, Roehl KA, Odibo AO, Cahill AG. First-trimester growth discordance and adverse pregnancy outcome in dichorionic twins. Ultrasound in Obstetrics & Gynecology 2012;41(6):627-31. - PubMed
Harper 2013 {published data only}
    1. Harper LM, Weis MA, Odibo AO, Roehl KA, Macones GA, Cahill AG. Significance of growth discordance in appropriately grown twins. American Journal of Obstetrics & Gynecology 2013;208(5):393. e1-5. - PubMed
Jensen 1992 {published data only}
    1. Jensen OH. Doppler velocimetry in twin pregnancy. European Journal of Obstetrics & Gynecology 1992;45(1):9-12. - PubMed
Kremkau 1978 {published data only}
    1. Kremkau FW, Nelson LH. Diagnostic ultrasound and its obstetric applications. American Family Physician 1978;17(5):148-57. - PubMed
Leombroni 2017 {published data only}
    1. Leombroni M, Liberati M, Fanfani F, Pagani G, Familiari A, Buca D, et al. Diagnostic accuracy of ultrasound in predicting birth weight discordance in twin pregnancy: systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology 2017;50(4):442-50. - PubMed
Nakano 2015 {published data only}
    1. Nakano JC, Liao AW, Brizot MdeL, Miyadahira M, Francisco RP, Zugaib M. Fetal growth according to different reference ranges in twin pregnancies with placental insufficiency. Clinics 2015;70(12):816-9. - PMC - PubMed
O'Brien 1986 {published data only}
    1. O'Brien WF, Knuppel RA, Scerbo JC, Rattan PK. Birth weight in twins: an analysis of discordancy and growth retardation. Obstetrics and Gynecology 1986;67(4):483-6. - PubMed
Ocer 2011 {published data only}
    1. Ocer F, Aydin Y, Atis A, Kaleli S. Factors affecting the accuracy of ultrasonographical fetal weight estimation in twin pregnancies. Journal of Maternal-fetal & Neonatal Medicine 2011;24(9):1168-72. - PubMed
Papaioannou 2011 {published data only}
    1. Papaioannou GI, Syngelaki A, Maiz N, Ross JA, Nicolaides KH. Prediction of outcome in dichorionic twin pregnancies at 6-10 weeks' gestation. American Journal of Obstetrics & Gynecology 2011;205(4):348. e1-5. - PubMed
Ropacka‐Lesiak 2012 {published data only}
    1. Ropacka-Lesiak M, Breborowicz G, Dera A. Blood flow changes in dichorionic twins with growth discordance. Twin Research and Human Genetics 2012;15(6):781-7. - PubMed
Senoo 2000 {published data only}
    1. Senoo M, Okamura K, Murotsuki J, Yaegashi N, Uehara S, Yajima A. Growth pattern of twins of different chorionicity evaluated by sonographic biometry. Obstetrics and Gynecology 2000;95(5):656-61. - PubMed
Shivkumar 2015 {published data only}
    1. Shivkumar S, Himes KP, Hutcheon JA, Platt RW. An ultrasound-based fetal weight reference for twins. American Journal of Obstetrics & Gynecology 2015;213(2):224. e1-9. - PubMed
Snijder 1998 {published data only}
    1. Snijder MJ, Wladimiroff JW. Fetal biometry and outcome in monochorionic vs. dichorionic twin pregnancies; a retrospective cross-sectional matched-control study. Ultrasound in Medicine and Biology 1998;24(2):197-201. - PubMed
Stirrup 2016 {published data only}
    1. Stirrup OT, Khalil A, D'Antonio F, Thilaganathan B. Patterns of second-and third-trimester growth and discordance in twin pregnancy: analysis of the Southwest Thames Obstetric Research Collaborative (STORK) Multiple Pregnancy Cohort. Fetal Diagnosis and Therapy 2016;41(2):100-7. - PubMed
Suzuki 2009 {published data only}
    1. Suzuki S, Shimizu E, Kinoshita M, Araki S. Accuracy of ultrasonographic fetal weight estimation in Japanese twin pregnancies. Journal of Medical Ultrasonics 2009;36(3):157-8. - PubMed
Weissmann‐Brenner 2012 {published data only}
    1. Weissmann-Brenner A, Weisz B, Achiron R, Shrim A. Can discordance in CRL at the first trimester predict birth weight discordance in twin pregnancies? Journal of Perinatal Medicine 2012;40(5):489-93. - PubMed
Xu 1995 {published data only}
    1. Xu B, Deter RL, Milner LL, Hill RM. Evaluation of twin growth status at birth using individualized growth assessment: comparison with conventional methods. Journal of Clinical Ultrasound 1995;23(5):277-86. - PubMed

Additional references

ACOG Committee 2004
    1. American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics, Society for Maternal-Fetal Medicine, ACOG Joint Editorial Committee. ACOG Practice Bulletin #56: Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy. Obstetrics and Gynecology 2004;104(4):869-83. - PubMed
Adegbite 2004
    1. Adegbite AL, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight. American Journal of Obstetrics and Gynecology 2004;190(1):156-8. - PubMed
Alfirevic 2003
    1. Alfirevic Z, Sundberg K, Brigham S. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No: CD003252. [DOI: 10.1002/14651858.CD003252] [PMID: ] - DOI - PMC - PubMed
Appleton 2007
    1. Appleton C, Pinto L, Centeno M, Clode N, Cardoso C, Graca LM, et al. Near term twin pregnancy: clinical relevance of weight discordance at birth. Journal of Perinatal Medicine 2007;35(1):62-6. - PubMed
Bagchi 2006
    1. Bagchi S, Salihu HM. Birth weight discordance in multiple gestations: occurrence and outcomes. Journal of Obstetrics and Gynaecology 2006;26(4):291-6. - PubMed
Behrendt 2016
    1. Behrendt N, Galan HL. Twin-twin transfusion and laser therapy. Current Opinion in Obstetrics & Gynecology 2016;28(2):79-85. [PMID: ] - PubMed
Bhide 2009
    1. Bhide A, Sankaran S, Sairam S, Papageorghiou AT, Thilaganathan B. Relationship of intertwin crown-rump length discrepancy to chorionicity, fetal demise and birth-weight discordance. Ultrasound in Obstetrics and Gynecology 2009;34(2):131-5. - PubMed
Chitkara 1985
    1. Chitkara U, Berkowitz GS, Levine R, Riden DJ, Fagerstrom RM Jr, Chervenak FA, et al. Twin pregnancy: routine use of ultrasound examinations in the prenatal diagnosis of intrauterine growth retardation and discordant growth. American Journal of Perinatology 1985;2(1):49-54. - PubMed
Chu 2006
    1. Chu H, Cole SR. Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach. Journal of Clinical Epidemiology 2006;59(12):1331-2. [PMID: ] - PubMed
de Vet 2013
    1. Vet HC, Eisinga A, Riphagen II, Aertgeerts B, Pewsner D. Chapter 7: Searching for studies. In: Deeks JJ, Bossuyt PM, Gatsonis C, editor(s). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0.0. The Cochrane Collaboration, 2013. Available from methods.cochrane.org/sdt/handbook-dta-reviews.
Deeks 2005
    1. Deeks JJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. Journal of Clinical Epidemiology 2005;58(9):882-93. - PubMed
Deeks 2019
    1. Deeks JJ, Higgins JP, Altman DG. Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated August 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Demissie 2002
    1. Demissie K, Ananth CV, Martin J, Hanley ML, MacDorman MF, Rhoads GG, et al. Fetal and neonatal mortality among twin gestations in the United States: the role of intrapair birth weight discordance. Obstetrics and Gynecology 2002;100(3):474-80. - PubMed
Devoe 1995
    1. Devoe LD, Wre DJ. Antenatal assessment of twin gestation. Seminars in Perinatology 1995;19(5):413. - PubMed
Di 2007
    1. Di Renzo GC, Rosati A, Sarti RD, Cruciani L, Cutuli AM. Does fetal sex affect pregnancy outcome? Gender Medicine 2007;4(1):19-30. [PMID: ] - PubMed
Dwamena 2009
    1. Dwamena B. MIDAS: Stata module for meta-analytical integration of diagnostic test accuracy studies, Statistical Software Components S456880, Boston College Department of Economics. ideas.repec.org/c/boc/bocode/s456880.html (accessed prior to 26 January 2021).
Gernt 2001
    1. Gernt PR, Mauldin JG, Newman RB, Durkalski VL. Sonographic prediction of twin birth weight discordance. Obstetrics and Gynecology 2001;97(1):53-6. - PubMed
Giles 1998
    1. Giles WB. Doppler ultrasound in multiple pregnancies. Bailliere's Clinical Obstetrics and Gynaecology 1998;12(1):77-89. - PubMed
Gonzalez‐Quintero 2003
    1. Gonzalez-Quintero VH, Luke B, O'Sullivan MJ, Misiunas R, Anderson E. Antenatal factors associated with significant birthweight discordancy in twin gestations. American Journal of Obstetrics and Gynecology 2003;189(3):83. - PubMed
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime) GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), accessed 1 July 2019. Available at gradepro.org.
Harbord 2007
    1. Harbord RM, Deeks JJ, Egger M, Whiting P, Sterne JA. A unification of models for meta-analysis of diagnostic accuracy studies. Biostatistics 2007;8:239-51. - PubMed
Harbord 2009
    1. Harbord RM, Whiting P. Metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata Journal 2009;9:211-29.
Hata 2011
    1. Hata T, Tanaka H, Noguchi J, Hata K. Three-dimensional ultrasound evaluation of the placenta. Placenta 2011;32(2):105-15. - PubMed
Jahanfar 2016a
    1. Jahanfar S, Lim K. A systematic review of birth weight discordance and perinatal outcomes. Fetal and Maternal Medicine Review 2016;1(1):1-31.
Jahanfar 2016b
    1. Jahanfar S, Lim K. Optimal threshold for birth weight discordance. Journal of Perinatology 2016;2:1-9. - PubMed
Jahanfar 2017a
    1. Jahanfar S, Lim K, Ovideo-Joekes E. Birth weight discordance and adverse perinatal outcomes. Journal of Perinatal Medicine 2017;45(5):603-11. [PMID: ] - PubMed
Kilic 2006
    1. Kilic M, Aygun C, Kaynar-Tuncel E, Küçüködük S. Does birth weight discordance in preterm twins affect neonatal outcome? Journal of Perinatology 2006;26(5):268-72. - PubMed
Klam 2003
    1. Klam S, Rinfret DE, Leduc L. Abdominal circumference ratio: a useful predictor of twin birth weight discordance. American Journal of Obstetrics and Gynecology 2003;189(6 Suppl):231.
Leeflang 2008
    1. Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM, Cochrane Diagnostic Test Accuracy Working Group. Systematic reviews of diagnostic test accuracy. Annals of Internal Medicine 2008;149(12):889-97. - PMC - PubMed
Lewi 2008
    1. Lewi L, Gucciardo L, Huber A, Jani J, Van Mieghem T, Done E, et al. Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth. American Journal of Obstetrics and Gynecology 2008;199(5):511.e1-7. - PubMed
Lopriore 2012
    1. Lopriore E, Pasman SA, Klumper FJ, Middeldorp JM, Walther FJ, Oepkes D, et al. Placental characteristics in growth-discordant monochorionic twins: a matched case-control study. Placenta 2012;33(3):171-4. - PubMed
Macaskill 2013
    1. Macaskill P, Gatsonis C, Deeks J, Harbord R, Takwoingi Y. Chapter 10: Analysing and presenting results. In: Deeks JJ, Bossuyt PM, Gatsonis C, editor(s). Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0.0. The Cochrane Collaboration, 2013. Available from srdta.cochrane.org.
Mahony 2006
    1. Mahony R, Foley M, Mcauliffe F, Mcparland P, Carroll S. Birth weight discordance, obstetric and perinatal outcome in twin pregnancies at term (37 weeks gestation). American Journal of Obstetrics and Gynecology 2006;195(6):S114.
Mazhar 2010
    1. Mazhar SB, Kanwal S. Twin birth weight discordance: associated factors and outcome. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2010;20(6):391-4. - PubMed
Melamed 2009
    1. Melamed N, Yogev Y, Glezerman M. Effect of fetal sex on pregnancy outcome in twin pregnancies. Obstetrics and Gynecology 2009;114(5):1085-92. - PubMed
Miller 2012
    1. Miller J, Chauhan SP, Abuhamad AZ. Discordant twins: diagnosis, evaluation and management. American Journal of Obstetrics and Gynecology 2012;206(1):10-20. - PubMed
Morin 2011
    1. Morin L, Lim K. Ultrasound in twin pregnancies. Journal of Obstetrics and Gynaecology Canada : JOGC 2011;33(6):643-56. - PubMed
NICE 2011
    1. National Institute for Health and Care Excellence. Multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period multiple pregnancy: the management of twin and triplet pregnancies in the antenatal period (CG129). www.nice.org.uk/guidance/cg129 (accessed October 2014).
Oerbekke 2020
    1. Oerbekke MS, Jenniskens K, Scholten RJ, Hooft L. Data sources and methods used to determine pretest probabilities in a cohort of Cochrane diagnostic test accuracy reviews. BMC Medical Research Methodology 2020;20(1):85. - PMC - PubMed
Okun 2000
    1. Okun N, Pastuzak A, Seaward G, Wilkinson J, Wilson D, Amankwah K, et al. The SOCG consensus statement: management of twin pregnancies (part 1). sogc.org/wp-content/uploads/2013/01/91E-CONS1-July2000.pdf (accessed October 2014).
Puccio 2014
    1. Puccio G, Giuffre M, Piccione M, Piro E, Malerba V, Corsello G. Intrauterine growth pattern and birthweight discordance in twin pregnancies: a retrospective study. Italian Journal of Pediatrics 2014;40:43. [PMID: ] - PMC - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rizzo 1993
    1. Rizzo G, Arduini D, Romanini C. Uterine artery Doppler velocity waveforms in twin pregnancies. Obstetrics and Gynecology 1993;82(6):978-83. - PubMed
Schünemann 2019
    1. Schünemann HJ, Mustafa RA, Brozek J, Santesso N, Bossuyt PM, Steingart KR, et al. GRADE guidelines: 22. The GRADE approach for tests and strategies – from test accuracy to patient-important outcomes and recommendations. Clinical Epidemiology 2019;111:69-82. - PubMed
Schünemann 2020a
    1. Schünemann HJ, Mustafa RA, Brozek J, Steingart KR, Leeflang M, Murad MH, et al. GRADE guidelines: 21 part 2. Test accuracy: inconsistency, imprecision, publication bias, and other domains for rating the certainty of evidence and presenting it in evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2020;122:142-52. - PubMed
Schünemann 2020b
    1. Schünemann HJ, Mustafa RA, Brozek J, Steingart KR, Leeflang M, Murad MH, et al. GRADE guidelines: 21 part 1. Study design, risk of bias, and indirectness in rating the certainty across a body of evidence for test accuracy. Journal of Clinical Epidemiology 2020;122:129-41. - PubMed
Tai 2007
    1. Tai J, Grobman WA. The association of crown-rump length discordance in twin gestations with adverse perinatal outcomes. American Journal of Obstetrics and Gynecology 2007;197(4):369.e1-4. - PubMed
Victoria 2001
    1. Victoria A, Mora G, Arias F. Perinatal outcome, placental pathology, and severity of discordance in monochorionic and dichorionic twins. Obstetrics and Gynecology 2001;97(2):310-5. [PMID: ] - PubMed
Wen 2006
    1. Wen SW, Tan H, Walker M. The association between intratwin birthweight discordance and preterm birth in twin pregnancy. Australian & New Zealand Journal of Obstetrics & Gynaecology 2006;46(5):402-6. - PubMed
Whiting 2011
    1. Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of Internal Medicine 2011;155(8):529-36. - PubMed
Woo 1939
    1. Woo J. A short history of the development of ultrasound in obstetrics and gynecology. www.ob-ultrasound.net/history3.html (accessed 28 January 2017).

References to other published versions of this review

Jahanfar 2017b
    1. Jahanfar S, Ho JJ, Jaafar SH, Abraha I, Nisenblat V, Ellis UM, et al+. Ultrasound for diagnosis of birth weight discordance in twin pregnancies. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No: CD012553. [DOI: 10.1002/14651858.CD012553] - DOI - PMC - PubMed

LinkOut - more resources