{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T12:36:20Z","timestamp":1775738180682,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T00:00:00Z","timestamp":1493856000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2017,5]]},"abstract":"Abstract<\/jats:title>Objective<\/jats:title>To assess the role of first\u2010 and early second\u2010trimester markers in the prediction of twin\u2010to\u2010twin transfusion syndrome (TTTS<\/jats:styled-content>) in monochorionic twin pregnancies.<\/jats:p><\/jats:sec>Methods<\/jats:title>Electronic databases MEDLINE<\/jats:styled-content>, EMBASE<\/jats:styled-content> and ClinicalTrials.gov<\/jats:ext-link> were searched from inception to April 2014, using the MeSH<\/jats:styled-content> term \u2018fetofetal transfusion\u2019 in combination with phrases \u2018predictive value\u2019, \u2018sensitivity\u2019, \u2018specificity\u2019, \u2018false positive\u2019, \u2018false negative\u2019, \u2018screening\u2019, \u2018accuracy\u2019 and \u2018ROC<\/jats:styled-content>\u2019. Study quality was assessed using the PRISMA<\/jats:styled-content> guidelines and QUADAS<\/jats:styled-content>\u20102 tool. A meta\u2010analysis was planned for the following predictive factors: intertwin nuchal translucency (NT<\/jats:styled-content>) discrepancy; NT<\/jats:styled-content>\u2009>\u200995th<\/jats:sup> percentile in at least one twin; intertwin crown\u2013rump length (CRL<\/jats:styled-content>) discrepancy as a percentage of the larger CRL<\/jats:styled-content>; abnormal ductus venosus (DV<\/jats:styled-content>) flow in at least one twin. The outcome assessed was TTTS<\/jats:styled-content>, defined according to the presence of a twin oligohydramnios\u2013polyhydramnios sequence. The diagnostic performance of the predictive factors was evaluated for each included study.<\/jats:p><\/jats:sec>Results<\/jats:title>The electronic search identified 152 records, of which 23 were assessed in full for eligibility. We identified 13 eligible studies that reported the predictive accuracy of ultrasound parameters, measured before 16\u2009weeks, for the development of TTTS<\/jats:styled-content>, including a total of 1991 pregnancies, of which 323 developed TTTS<\/jats:styled-content>. An increased risk of TTTS<\/jats:styled-content> was associated with: intertwin NT<\/jats:styled-content> discrepancy (positive likelihood ratio (LR<\/jats:styled-content>+), 1.92 (95% CI<\/jats:styled-content>, 1.25\u20132.96); negative likelihood ratio (LR<\/jats:styled-content>\u2013), 0.65 (95% CI<\/jats:styled-content>, 0.50\u20130.84)); NT<\/jats:styled-content>\u2009>\u200995th<\/jats:sup> percentile (LR<\/jats:styled-content>+, 2.63 (95% CI<\/jats:styled-content>, 1.51\u20134.58); LR<\/jats:styled-content>\u2013, 0.85 (95% CI<\/jats:styled-content>, 0.75\u20130.96)); CRL<\/jats:styled-content> discrepancy\u2009>\u200910% (LR<\/jats:styled-content>+, 1.80 (95% CI<\/jats:styled-content>, 1.05\u20133.07); LR<\/jats:styled-content>\u2013, 0.92 (95% CI<\/jats:styled-content>, 0.81\u20131.05)); abnormal DV<\/jats:styled-content> flow (LR<\/jats:styled-content>+, 4.77 (95% CI<\/jats:styled-content>, 1.33\u201317.04; LR<\/jats:styled-content>\u2013, 0.49 (95% CI<\/jats:styled-content>, 0.17\u20131.41)). The highest sensitivities were observed for intertwin NT<\/jats:styled-content> discrepancy (52.8% (95% CI<\/jats:styled-content>, 43.8\u201361.7%)) and abnormal DV<\/jats:styled-content> flow (50.0% (95% CI<\/jats:styled-content>, 33.4\u201366.6%)).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Monochorionic twin pregnancies with intertwin NT<\/jats:styled-content> discrepancy, NT<\/jats:styled-content>\u2009>\u200995th<\/jats:sup> percentile, intertwin CRL<\/jats:styled-content> discrepancy\u2009>\u200910% or abnormal DV<\/jats:styled-content> flow on first\u2010trimester ultrasound examination are at significantly increased risk of developing TTTS<\/jats:styled-content>. Copyright \u00a9 2016 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.15989","type":"journal-article","created":{"date-parts":[[2016,6,7]],"date-time":"2016-06-07T09:03:03Z","timestamp":1465290183000},"page":"573-582","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Early prediction of twin\u2010to\u2010twin transfusion syndrome: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"49","author":[{"given":"V.","family":"Stagnati","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Brescia Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Zanardini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Brescia Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Fichera","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Brescia Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Pagani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Brescia Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. A.","family":"Quintero","sequence":"additional","affiliation":[{"name":"Jackson Fetal Therapy Institute Jackson Memorial Hospital Miami FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Bellocco","sequence":"additional","affiliation":[{"name":"Department of Statistics and Quantitative Methods University of Milano\u2010Bicocca Milan Italy"},{"name":"Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Brescia Brescia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,5,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4643"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_6_4_1","first-page":"107","article-title":"Twin\u2010to\u2010twin transfusion syndrome (TTTS)","volume":"39","author":"WAPM Consensus Group on Twin\u2010to\u2010Twin Transfusion","year":"2011","journal-title":"J Perinat Med"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2010.12.045"},{"key":"e_1_2_6_6_1","volume-title":"Management of Monochorionic Twin Pregnancy","author":"Royal College of Obstetricians and Gynaecologists (RCOG)","year":"2008"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000446856.51061.3e"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2008.27.3.363"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1802"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2010.09.375"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.4006"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.005"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1375\/twin.12.6.605"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31819c9f66"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050500232565"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7533"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03250.x"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/15.9.2008"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3918"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3819"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1998.11050324.x"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/15.7.1632"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2285"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2007.087890"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1159\/000348771"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2012.01507.x"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1159\/000088043"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.8802"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-2-9"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.06.0226"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-12-200812160-00008"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-8-201110180-00009"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15821"},{"key":"e_1_2_6_34_1","unstructured":"National Institute for Health and Clinical Excellence (NICE) 2011 NICE London"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.10.880"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1997.10020082.x"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2014.960834"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2013.08.009"}],"container-title":["Ultrasound in Obstetrics & Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.15989","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.15989","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.15989","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.15989","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.15989","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T10:39:09Z","timestamp":1692527949000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.15989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2017,5]]}},"alternative-id":["10.1002\/uog.15989"],"URL":"https:\/\/doi.org\/10.1002\/uog.15989","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5]]},"assertion":[{"value":"2015-09-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-05-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-05-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}