Rl. Deter et al., PRENATAL PREDICTION OF NEONATAL GROWTH STATUS IN TWINS USING INDIVIDUALIZED GROWTH ASSESSMENT, Journal of clinical ultrasound, 24(2), 1996, pp. 53-59
Citations number
17
Categorie Soggetti
Radiology,Nuclear Medicine & Medical Imaging",Acoustics
Objective: To determine if the growth status at birth of twins can be
predicted in the third trimester using the Prenatal Growth Assessment
Score (PGAS). Methods: The growth of 40 twin fetuses were studied with
ultrasound from 14 weeks until delivery. Measurements of the head cir
cumference (HC), abdominal circumference (AC), thigh circumference (Th
C), femur diaphysis length (FDL), head cube (A), and abdominal cube (B
) were made at 2 to 3 week intervals. Rossavik growth models for these
parameters were determined from second trimester measurements. These
models were used to define expected third trimester growth curves and
birth characteristics. Comparisons of expected and actual third trimes
ter measurements were used to calculate PGAS values after various time
points (PGAS(At)) and after the last time point (PGAS(AT)). Similar c
omparisons after birth were used to determine Growth Potential Realiza
tion Index (GPRI) values for HC, AC, ThC, weight (WT), and crown-heel
length (CHL), with and without correction for decreased soft tissue de
position. These two sets of GPRI values were used to calculate two set
s of Neonatal Growth Assessment Scores (NGAS(S), NGAS(Tw)). Using NGAS
(S) and NGAS(Tw) (as well as GPRI values in some cases), the twin neon
ates were classified as Normal (N), Decreased Soft Tissue Deposition,
(DSTD), Intrauterine Growth Retardation (IUGR), and Macrosomia (M). Re
sults: At birth 22/40 (55%) were classified as N, 9/40 (22.5%) as DSTD
, 6/40 (15.0%) as IUGR, and 3/40 (7.5%) as M. All -PGAS(AT) values in
the N group were greater than -0.40% with one exception (-PGAS(AT) = -
0.43%). All PGAS(At) values were above this same boundary except for o
ne fetus. No differences were seen between the N and DSTD groups [mean
-PGAS(AT) (range): N, -0.12% (0% to -0.34%); DSTD, -0.10% (0% to -0.3
0%)]. The IUGR group had 4 fetuses with -PGAS(AT) values between -0.65
% and 2.79% and two with values of 0.0% and -0.12%. Growth retardation
in the latter two was limited to a decrease in thigh soft tissue depo
sition. -PGAS(At) values in the first 4 fetuses were below -0.40% 1.6
to 9.5 weeks before delivery (mean: 6.1 weeks). Fetuses in group M had
+PGAS(AT) values of 0.0%, +1.8%, and +1.2%. PGAS(At) values were abov
e +0.40% at 3.6 and 9.8 weeks before delivery in the latter two fetuse
s. Conclusions: These results support the concept that PGAS(AT) and PG
AS(At) values outside +/-0.40% indicate either IUGR or macrosomia. Alm
ost all fetuses with growth problems in the third trimester can be det
ected, on average, 6 weeks before delivery unless the growth abnormali
ty is limited to decreased soft tissue deposition. (C) 1996 John Wiley
& Sons, Inc.