Predicting Adverse Perinatal Outcomes in Dichorionic Twin Pregnancies: A Multicentre Cohort Study.

Area of Science:

• Perinatal medicine
• Maternal-fetal medicine
• High-risk pregnancy management

Background:

• Dichorionic twin pregnancies face elevated risks of stillbirth and early preterm birth.
• Accurate prediction of adverse perinatal outcomes is essential for timely intervention.

Purpose of the Study:

• To evaluate the predictive value of fetal estimated weight (EFW) and Doppler indices for adverse perinatal outcomes in dichorionic twins.
• To develop a predictive model for stillbirth or medically indicated early preterm birth (ePTB).

Main Methods:

• Retrospective multicentre cohort study of 1294 dichorionic twin pregnancies.
• Analysis of fetal estimated weight (EFW) discordance and Doppler indices (umbilical artery PI, middle cerebral artery PI) within two weeks of birth.
• Univariable and multivariable analyses to assess predictive accuracy.

Main Results:

• Adverse perinatal outcomes occurred in 4.5% of pregnancies.
• Significant differences were observed in small for gestational age fetuses, EFW discordance, umbilical artery (UA) PI discordance, and middle cerebral artery PI discordance between affected and unaffected twins.
• A model combining EFW discordance and UA PI discordance demonstrated high predictive accuracy (AUC=0.90).

Conclusions:

• Integration of intertwin EFW and UA PI discordance effectively predicts stillbirths or medically indicated ePTB.
• This predictive model offers potential for risk stratification in dichorionic pregnancies.
• Further external validation is recommended to refine targeted interventions and improve clinical outcomes.