Accuracy of sonographic chorionicity classification in twin gestations

Yair J. Blumenfeld, Valerija Momirova, Dwight J. Rouse, Steve N. Caritis, Anthony Sciscione, Alan M. Peaceman, Uma M. Reddy, Michael W. Varner, Fergal D. Malone, Jay D. Iams, Brian M. Mercer, John M. Thorp, Yoram Sorokin, Marshall W. Carpenter, Julie Lo, Susan M. Ramin, Margaret Harper

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objectives - To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. Methods - We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. Results - A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Conclusions - Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.

Original languageEnglish (US)
Pages (from-to)2187-2192
Number of pages6
JournalJournal of Ultrasound in Medicine
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2014

Fingerprint

Gestational Age
Ultrasonography
Pregnancy
Maternal Age
Body Mass Index
Odds Ratio
Fetofetal Transfusion
Confidence Intervals
Oligohydramnios
Polyhydramnios
Twin Pregnancy
Premature Birth
Parity
Placenta
Obstetrics
Hemorrhage
Hypertension
Sensitivity and Specificity

Keywords

  • Accuracy
  • Chorionicity
  • Obstetric ultrasound
  • Sonography
  • Twins

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Blumenfeld, Y. J., Momirova, V., Rouse, D. J., Caritis, S. N., Sciscione, A., Peaceman, A. M., ... Harper, M. (2014). Accuracy of sonographic chorionicity classification in twin gestations. Journal of Ultrasound in Medicine, 33(12), 2187-2192. https://doi.org/10.7863/ultra.33.12.2187

Accuracy of sonographic chorionicity classification in twin gestations. / Blumenfeld, Yair J.; Momirova, Valerija; Rouse, Dwight J.; Caritis, Steve N.; Sciscione, Anthony; Peaceman, Alan M.; Reddy, Uma M.; Varner, Michael W.; Malone, Fergal D.; Iams, Jay D.; Mercer, Brian M.; Thorp, John M.; Sorokin, Yoram; Carpenter, Marshall W.; Lo, Julie; Ramin, Susan M.; Harper, Margaret.

In: Journal of Ultrasound in Medicine, Vol. 33, No. 12, 01.12.2014, p. 2187-2192.

Research output: Contribution to journalArticle

Blumenfeld, YJ, Momirova, V, Rouse, DJ, Caritis, SN, Sciscione, A, Peaceman, AM, Reddy, UM, Varner, MW, Malone, FD, Iams, JD, Mercer, BM, Thorp, JM, Sorokin, Y, Carpenter, MW, Lo, J, Ramin, SM & Harper, M 2014, 'Accuracy of sonographic chorionicity classification in twin gestations', Journal of Ultrasound in Medicine, vol. 33, no. 12, pp. 2187-2192. https://doi.org/10.7863/ultra.33.12.2187
Blumenfeld YJ, Momirova V, Rouse DJ, Caritis SN, Sciscione A, Peaceman AM et al. Accuracy of sonographic chorionicity classification in twin gestations. Journal of Ultrasound in Medicine. 2014 Dec 1;33(12):2187-2192. https://doi.org/10.7863/ultra.33.12.2187
Blumenfeld, Yair J. ; Momirova, Valerija ; Rouse, Dwight J. ; Caritis, Steve N. ; Sciscione, Anthony ; Peaceman, Alan M. ; Reddy, Uma M. ; Varner, Michael W. ; Malone, Fergal D. ; Iams, Jay D. ; Mercer, Brian M. ; Thorp, John M. ; Sorokin, Yoram ; Carpenter, Marshall W. ; Lo, Julie ; Ramin, Susan M. ; Harper, Margaret. / Accuracy of sonographic chorionicity classification in twin gestations. In: Journal of Ultrasound in Medicine. 2014 ; Vol. 33, No. 12. pp. 2187-2192.
@article{b0e0645e770340efb6e45f0acb2eaf70,
title = "Accuracy of sonographic chorionicity classification in twin gestations",
abstract = "Objectives - To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. Methods - We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. Results - A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4{\%}): 18 of 455 dichorionic twins (4.0{\%}) and 17 of 90 monochorionic twins (19.0{\%}). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1{\%} and 96.0{\%}, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95{\%} confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10{\%} (OR, 1.10; 95{\%} CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Conclusions - Sonography before 20 weeks incorrectly classified chorionicity in 6.4{\%} of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.",
keywords = "Accuracy, Chorionicity, Obstetric ultrasound, Sonography, Twins",
author = "Blumenfeld, {Yair J.} and Valerija Momirova and Rouse, {Dwight J.} and Caritis, {Steve N.} and Anthony Sciscione and Peaceman, {Alan M.} and Reddy, {Uma M.} and Varner, {Michael W.} and Malone, {Fergal D.} and Iams, {Jay D.} and Mercer, {Brian M.} and Thorp, {John M.} and Yoram Sorokin and Carpenter, {Marshall W.} and Julie Lo and Ramin, {Susan M.} and Margaret Harper",
year = "2014",
month = "12",
day = "1",
doi = "10.7863/ultra.33.12.2187",
language = "English (US)",
volume = "33",
pages = "2187--2192",
journal = "Journal of Ultrasound in Medicine",
issn = "0278-4297",
publisher = "American Institute of Ultrasound in Medicine",
number = "12",

}

TY - JOUR

T1 - Accuracy of sonographic chorionicity classification in twin gestations

AU - Blumenfeld, Yair J.

AU - Momirova, Valerija

AU - Rouse, Dwight J.

AU - Caritis, Steve N.

AU - Sciscione, Anthony

AU - Peaceman, Alan M.

AU - Reddy, Uma M.

AU - Varner, Michael W.

AU - Malone, Fergal D.

AU - Iams, Jay D.

AU - Mercer, Brian M.

AU - Thorp, John M.

AU - Sorokin, Yoram

AU - Carpenter, Marshall W.

AU - Lo, Julie

AU - Ramin, Susan M.

AU - Harper, Margaret

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Objectives - To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. Methods - We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. Results - A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Conclusions - Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.

AB - Objectives - To evaluate the accuracy of sonographic classification of chorionicity in a large cohort of twins and investigate which factors may be associated with sonographic accuracy. Methods - We conducted a secondary analysis of a randomized trial of preterm birth prevention in twins. Sonographic classification of chorionicity was compared with pathologic examination of the placenta. Maternal (age, body mass index, diabetes, and hypertension), obstetric (prior cesarean delivery, gestational age at the first sonographic examination, and antepartum bleeding), and sonographic (oligohydramnios, polyhydramnios, and twin-twin transfusion syndrome) factors were assessed for their possible association with accuracy. Results - A total of 545 twin sets in which chorionicity was classified by sonography before 20 weeks' gestation were included; 455 were dichorionic and 90 were monochorionic based on pathologic examination. Sonography misclassified 35 of 545 twin pregnancies (6.4%): 18 of 455 dichorionic twins (4.0%) and 17 of 90 monochorionic twins (19.0%). The sensitivity and specificity of sonographic diagnosis of monochorionicity were 81.1% and 96.0%, respectively. In a multivariable analysis, pregnancies with initial sonographic examinations before 14 weeks' gestation were less likely to have misclassified chorionicity than those with sonographic examinations at 15 to 20 weeks (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.23-0.96). For each week increase in gestational age, the odds of misclassification rose by 10% (OR, 1.10; 95% CI, 1.01-1.2). In the multivariable analysis, maternal age, body mass index, parity, and prior cesarean delivery were not associated with sonographic accuracy. Conclusions - Sonography before 20 weeks incorrectly classified chorionicity in 6.4% of twin gestations. Those with first sonographic examinations performed at earlier gestational ages had improved chorionicity diagnosis.

KW - Accuracy

KW - Chorionicity

KW - Obstetric ultrasound

KW - Sonography

KW - Twins

UR - http://www.scopus.com/inward/record.url?scp=84919385564&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919385564&partnerID=8YFLogxK

U2 - 10.7863/ultra.33.12.2187

DO - 10.7863/ultra.33.12.2187

M3 - Article

C2 - 25425377

AN - SCOPUS:84919385564

VL - 33

SP - 2187

EP - 2192

JO - Journal of Ultrasound in Medicine

JF - Journal of Ultrasound in Medicine

SN - 0278-4297

IS - 12

ER -