Blood Flow Changes in Dichorionic Twins With Growth Discordance

Abstract

Aim: The study evaluated the applicability of Doppler ultrasonography in predicting the course of pregnancy and neonatal outcome in dichorionic pregnancy complicated by growth discordance. Methods: Doppler examination of the umbilical artery (UA) and middle cerebral artery (MCA) was performed in 106 twins. Abnormal values of the UA pulsatility index (PI) were considered to be above the 95th percentile and below 5th percentile for the MCA PI for gestational week. The difference of UA PI ≥0.5 in twin pairs was considered abnormal. Doppler results were compared with selected parameters that characterize the course of pregnancy and fetal outcome. Results: Abnormal UA PI as well as the intertwine PI difference of 0.5 and more correlated significantly with lower gestational age at delivery, intertwine growth discordance of 35% or more, lower birth weight, and abnormal fetal outcome. The abnormal cerebro-umbilical (C/U) ratio correlated statistically with lower birth weight, abnormal fetal outcome, and an increased risk of premature delivery. There were no statistically significant differences in the majority of parameters that characterize the neonatal outcome between the groups with normal and abnormal MCA PI. Conclusion: The intertwine UA PI difference ≥0.5 had the highest predictive value in the assessment of adverse fetal outcome and risk for small for gestational age (SGA). Relatively poor sensitivity was noted with regard to the abnormal values of UA PI and C/U ratio. The worse correlation was found in case of MCA PI.

Identification of placental genes linked to selective intrauterine growth restriction (IUGR) in dichorionic twin pregnancies: gene expression profiling study

“…For twin pregnancies, IUGR is a condition in which one or two siblings do not grow well. In addition, various criteria exist for IUGR diagnosis twin pregnancies; however, the following two are used most frequently: (1) either twin with a birth weight < 10th percentile for gestational age, (2) the presence of a 10–30% difference in birthweight between co-twins (Breathnach and Malone 2012 ; Moore and O’Brien 2006 ; Ropacka-Lesiak et al 2012 ; Yinon et al 2005 ).…”

Selective Intrauterine Growth Restriction in Monochorionic Twin Pregnancies: Markers of Endothelial Damage and Metabolomic Profile

“…In this perspective, research on twin fetuses provides a unique opportunity to mimic a scientific experiment to study IUGR and, reflecting nutritional stresses within a similar genetic fetal background, to distinguish between genetic and environmental causes of phenotypic variations in the human population (Muhlhusler et al, 2011). The cause of discordant growth in MC twin pregnancies probably originates from a variety of conditions: limited maternal uterine environment, intertwin distribution of blood and nutrients along vascular placental anastomosis, unequal placental sharing, abnormal cord insertion, or impaired transport of amino acids through the placenta (Bajoria et al, 2001; Ijzerman et al, 2005; Ropacka-Lesiak et al, 2012; Valsky et al, 2010).…”

Clinical Outcome of Monochorionic Diamniotic Twins with Intrauterine Growth Restriction

“…[17][18][19] A previous study reported that in 39 cases of sIUGR, type I sIUGR represented an average gestational age of 35.4 weeks, less than 3% of intrauterine mortality, and 90% of perinatal survival rate. 18,20 Herein, on the one hand, the sIUGR patients had the highest intrauterine death rate (16.3% vs. 0), which was linked to the smallest fraction of the tiniest placenta. On the other hand, the improved diameter of the arteriolar anastomosis supported the necessity of close monitoring of sIUGR to prevent intrauterine mortality.…”