An ultrasound-based fetal weight reference for twins.

OBJECTIVE The objective of the study was to construct an ultrasound-based estimated fetal weight-for-gestational-age reference for twin fetuses, stratified by chorionicity. STUDY DESIGN We performed a retrospective cohort study of live-born nonanomalous twins delivered longer than 34 weeks at the Royal Victoria Hospital (Montreal, Canada). Fetal weight was estimated using ultrasound biometric measurements combined using Hadlock's formula. Multilevel linear regression models were used to adjust for clustering by twin pregnancy and to account for the serial ultrasound measurements taken on each fetus. Based on this model, smoothed estimates of fetal weight were made for the third, 10th, 50th, 90th, and 97th percentiles of the fetal weight distribution. Fetal weight references were stratified by fetal chorionicity. RESULTS A total of 642 twin fetuses with a total of 3078 ultrasound observations were included. Sixteen percent of the cohort was monochorionic. Fetal growth accelerated in the second trimester and continued in a linear pattern in the third trimester until term. As expected, the median weight for monochorionic twins was lighter than the median weight for dichorionic twins throughout pregnancy. CONCLUSION The reference values created in this study address serious methodological limitations of existing reference charts and thus provide an improved tool for assessing fetal growth in twin pregnancies. Importantly, dichorionic twins deviated from singleton reference charts at approximately 32 weeks, whereas monochorionic twins deviated at 28 weeks.