| Screening for twin-twin transfusion syndrome at 11-14 weeks of pregnancy: the key role of ductus venosus blood flow assessment. | |
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MedLine Citation:
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PMID: 20069677 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: A discrepancy in crown-rump length (CRL) and/or nuchal translucency thickness (NT) between monochorionic twins has been found to be associated with an increased risk of twin-twin transfusion syndrome (TTTS). As one of the most plausible mechanisms for increased NT is hemodynamic imbalance and cardiac dysfunction, indirectly manifested by abnormal blood flow in the ductus venosus (DV), we aimed to clarify the role of DV blood flow assessment in identifying those monochorionic twins more prone to develop TTTS. METHODS: We present 99 cases of monochorionic diamniotic twin pregnancies in which CRL, NT and DV blood flow were evaluated at 11-14 weeks' gestation. RESULTS: Discrepant values of CRL were not predictive of TTTS development. Intertwin NT discrepancy >or= 0.6 mm had a sensitivity of 50.0% and a specificity of 92.0%. The presence of at least one abnormal blood flow waveform in the DV was associated with a relative risk for developing TTTS of 11.86 (95% CI, 3.05-57.45), with a sensitivity of 75.0% and a specificity of 92.0%. The combination of abnormal DV blood flow with NT discrepancy >or= 0.6 mm yielded a relative risk for the development of TTTS of 21 (95% CI, 5.47-98.33). CONCLUSIONS: Both intertwin discrepancy in NT and abnormal flow in the DV in monochorionic twins may represent early manifestations of hemodynamic imbalance between donor and recipient. In these pregnancies, in addition to NT measurement at 11-14 weeks, the Doppler assessment of DV blood flow significantly increases the performance of screening for those at risk of developing TTTS. |
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Authors:
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A Matias; N Montenegro; T Loureiro; M Cunha; S Duarte; D Freitas; M Severo |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 35 ISSN: 1469-0705 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-02-01 Completed Date: 2010-09-14 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: England |
Other Details:
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Languages: eng Pagination: 142-8 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, Faculty of Medicine, Hospital of S. João, Porto, Portugal. almatias@mail.telepac.pt |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Flow Velocity
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physiology Crown-Rump Length* Female Fetal Heart / physiopathology*, ultrasonography Fetofetal Transfusion / physiopathology*, ultrasonography Humans Liver / blood supply Nuchal Translucency Measurement / methods Pregnancy Prospective Studies Twins Ultrasonography, Prenatal Umbilical Veins / physiopathology* Vena Cava, Inferior / embryology, physiopathology* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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