OC228: Intra-amniotic Doppler assessment of blood flow of individual placental vascular anastomoses in twin-twin transfusion syndrome

Abstract

Objectives: 1) To assess the accuracy of fetal echocardiography in multiple pregnancy, and 2) To evaluate the type of congenital heart disease (CHD) and of extracardiac anomalies detected in 36 cases of multiple pregnancy. Method : We analysed a population of 248 pregnancies (546 fetuses, 39 with CHD). Diagnostic accuracy was calculated for fetal echocardiography. In fetuses with CHD, the following variables were analysed: chorionicity, gestational age at diagnosis, type of CHD, associated chromosomal and extracardiac abnormalities, fetoneonatal outcome. Results: In this series, sensitivity was 88.8%, specificity 99.8%, PPV 97.1% and NPV 99.1%. There were 4 FP and 1 FN cases. The association with aneuploidy was 9.3% (3/32). The spectrum of CHD was similar to that seen in singleton during the same period of time. Of note, that 8/32 (25.0%) fetuses with CHD were recipients from monochorionic pregnancies complicated by TTTS. As for the outcome, 21 (65.6%) neonates survived and 11 (34.4%) died prior to (9) or after surgery (2). Conclusions: Fetal echocardiography is clearly feasible also in multiple pregnancy without particular difficulties, at least for twins. In triplets and quadruplets, fetal crowding makes things a great deal more difficult. The association with aneuploidy is lower than expected, possibly due to the low incidence of extracardiac anomalies in this series and to the relatively small number of cases. As to the outcome, low birthweight coupled with CHD seem to be an important bad prognostic indicator, be it for growth restriction or simply prematurity.