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First-trimester ultrasound dating of twin pregnancy: are singleton charts reliable?
T Dias1, S Mahsud-Dornan, B Thilaganathan
1Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK.
Objective:
The aim of this study was to assess the performance of validated singleton crown-rump length (CRL) formulae in dating twin pregnancies at 11-14 weeks of gestation.
Design:
Retrospective cohort study.
Setting:
Fetal medicine unit of a London teaching hospital.
Sample:
Three hundred and eighty-four pregnancies with known dates of conception.
Methods:
Retrospective analysis of 266 singletons and 118 twin pregnancies conceived by in vitro fertilisation (IVF), with a known date of conception. The gestation calculated from the date of conception was compared with the expected gestation from fetal size using a number of different CRL formulae.
Main Outcome Measures:
Difference in gestational age computed from fetal size (CRL) of the bigger and smaller fetus in twin pregnancies and singleton pregnancies using three formulae.
Results:
Two of the three studied CRL formulae systematically underestimated the mean gestational age and size of singleton IVF pregnancies (Robinson formula: gestation = 1.4 days, size = 2.7 mm). Twin CRL measurements straddled those of singletons, regardless of the CRL formula used (Robinson formula: larger twin gestation = 2.4 days, size = 4.7 mm; smaller twin gestation = 0.8 days, size = 1.7 mm). These underestimates in gestation and size for IVF singleton and twin pregnancies are well within the known limits of accuracy of first = trimester ultrasound measurements, and are of limited clinical significance.
Conclusions:
Currently available CRL charts underestimate both the age and size of IVF singleton pregnancies by a clinically insignificant amount. This difference is similar for twin pregnancies, suggesting that singleton CRL charts can be used to date twin pregnancies accurately.
