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Ultrasound in the Diagnosis of Twin-to-Twin Transfusion Syndrome – a Preliminary Report

Published online by Cambridge University Press:  01 August 2014

M. Ropacka ,
W. Markwitz ,
W. Ginda  and
G. H. Bręborowicz
M. Ropacka*
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
W. Markwitz
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
W. Ginda
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
G. H. Bręborowicz
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
*
Klinika Perinatologii i Ginekologii, Ginekologiczno-Położniczy Szpital Kliniczny Akademii Medycznej, 60-535 Poznań, ul. Polna 33, Polska

Abstract

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Objective. The aim of this study was to show the diagnostic possibilities of ultrasound in twin-to-twin transfusion syndrome (TTTS), to demonstrate its usefulness in cases of hemoglobin difference < 5 g/dL in neonates as well as in cases complicated by intrauterine death of one or both twins.

Study design. The study included 4 pairs of twins. In two cases 3 fetuses died in utero. In the other two the hemoglobin difference in newborn infants was < 5 g/dL. The ultrasound examination, evaluating the fetal anatomy and biometry, amniotic fluid volume, placentation, was performed. The special attention was paid to polyhydramnios/oligohydramnios, discordant fetal growth (fetal weight, abdominal circumference), the presence of fetal hydrops, ascites, pericardial effusion. Doppler blood flow velocimetry has been done in umbilical vessels, middle cerebral artery. The data was compared with normal reference values for singleton pregnancies. The waveforms from both uterine arteries were also evaluated to exclude placental insufficiency. Additionally the blood flow through the AV valves was measured to exclude or confirm its regurgitation. Postnatally the hemoglobin difference was evaluated if available and compared with sonographic findings.

Results. In all cases inter-twin difference in abdominal circumference was greater than 18 mm and inter-twin weight difference of more than 15%. We observed polyhydramnios/oligohydramnios in all twin pregnancies.

It has been found decreased PI in middle cerebral artery in larger fetus (recipient) in all our cases (comparing to single pregnancy). PI values for this vessel in smaller fetuses were within normal range (for single pregnancy). PI values in umbilical arteries of recipients were abnormal (increased PI or absent end-diastolic flow).

Comments. The sonographic criteria seem to be very useful in diagnosis of twin-to-twin transfusion syndrome, especially in cases where the measurement of hemoglobin level is impossible. Doppler blood flow velocimetry in fetal vessels helps to explain the changes in fetal hemodynamics in TTTS.

Keywords

Twin-to-twin transfusion (TTTS) syndromePrenatal ultrasoundDoppler blood flow velocimetry
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 47 , Issue 3-4 , October 1998 , pp. 227 - 237
Copyright
Copyright © The International Society for Twin Studies 1998

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