Introduction: Twin anemia-polycythemia sequence (TAPS) is a complication in monochorionic-diamniotic (MCDA) twin pregnancies. This study analyzes whether the prenatal diagnosis using delta middle cerebral artery-peak systolic velocity (MCA-PSV) > 0.5 multiples of the median (MoM) (delta group) detects more TAPS cases than the guideline-based diagnosis using the MCA-PSV cut off levels of >1.5 and <1.0 MoM (cut-off group), in a heterogenous group of MCDA twins. Methods: A retrospective analysis of 348 live-born MCDA twin pregnancies from 2010 to 2021 with available information on MCA-PSV within one week before delivery and hemoglobin-values within 24 h postnatally were considered eligible. Results: Among postnatal confirmed twin pairs with TAPS, the cut-off group showed lower sensitivity than the delta group (33% vs. 82%). Specificity proved higher in the cut-off group with 97% than in the delta group at 86%. The risk that a TAPS is mistakenly not recognized prenatally is higher in the cut-off group than in the delta group (52% vs. 18%). Conclusions: Our data shows that delta MCA-PSV > 0.5 MoM detects more cases of TAPS, which would not have been diagnosed prenatally according to the current guidelines. In the collective examined in the present study, TAPS diagnostics using delta MCA-PSV proved to be a more robust method.
Objectives: Radiofrequency ablation (RFA) is one of the best methods of fetal reduction to improve monochorionic pregnancy outcome; however, twins treated by RFA are still at increased risk of neurodevelopmental impairment. The aim of this study was to investigate the accuracy of fetal ultrasound, conventional magnetic resonance imaging (MRI), and diffusion-weighted imaging (DWI), in diagnosis of intracranial lesions especially hypoxic ischemic brain injury in the survivors. Methods: 43 monochorionic twins with mean gestational age of 20.2 weeks underwent RFA and were assessed between 2018-2020 by ultrasound and MRI (conventional and DWI sequences). Fetal brain imaging was performed in the surviving fetuses, at early (within 10 days after RFA) and late phase (after 3-6 weeks), to determine both acute and chronic ischemic lesions. Presence of anemia after RFA was also evaluated by Doppler ultrasound. Results: Overall, 13 of total 43 (30.2%) fetuses demonstrated MRI abnormalities with normal brain ultrasound results and no anemia including ten germinal matrix hemorrhage (GMH), two extensive cerebral ischemia in DWI and one mild ventriculomegaly. Also, totally 13 (30.2%) fetuses died in utero including 6 fetuses because of PROM, and two cases with extensive cerebral infarct and 5 cases with unknown etiology. Seven fetuses with GMH were eventually born alive with normal outcome. Besides, anemia was noted in 3 (6.9%) fetuses without abnormal findings on MRI. The postnatal investigations of the survivors showed no abnormalities. Conclusions: Fetal brain DWI can detect early intracranial ischemic changes in monochorionic pregnancies after RFA of one fetus, better than ultrasound. GMH seems to be a frequent finding and can be considered with little clinical significance. Normal brain ultrasound and no evidence of anemia in Doppler exam do not necessarily rule out fetal brain ischemia, and performing DWI in early phase is helpful in multiple pregnancies undergoing RFA for better management of pregnancy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.