The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

Abstract

This study aimed to investigate the value of echocardiography and Doppler before fetoscopic laser coagulation for twin‐twin transfusion syndrome (TTTS) in the prediction of intrauterine fetal demise (IUFD). We performed a systematic review and meta‐analysis to compare preoperative parameters between fetuses with and without demise after laser surgery. Eighteen studies were included. Recipient twins have an increased risk of demise in case of preoperative absent/reversed flow (A/REDF) in the umbilical artery (odds ratio [OR] 2.76, 95% confidence interval [CI], 1.78‐4.28), absent or reversed a‐wave in the ductus venosus (OR 2.32, 95% CI, 1.70‐3.16), or a middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) (OR 7.59, 95% CI, 2.56‐22.46). In donors, only A/REDF in the umbilical artery (OR 3.40, 95% CI, 2.68‐4.32) and absent or reversed a‐wave in the ductus venosus (OR 1.66, 95% CI, 1.12‐2.47) were associated with IUFD. No association was found between donor‐IUFD and preoperative myocardial performance index (MPI). Two studies found an association between abnormal MPI and recipient demise. With this study, we have identified a set of preoperative Doppler parameters predictive of fetal demise after laser surgery. More research is needed to assess the utility of preoperative echocardiographic parameters such as the MPI in predicting IUFD.

Nonimmune Fetal Anemia: Exploring the Unfathomed! Case Series and Review of Literature

“…22 It results in oliguric oligohydramnios in the donor and polyuric polyhydramnios and volume overload in the recipient, causing hydrops due to right ventricular dysfunction. 23,24 Early stages of TTTS (stages 1 and 2) are managed conservatively by amnioreduction and or septostomy while advanced stages of TTTS (stages 3 and 4) are managed by laser photocoagulation of abnormal anastomoses or radiofrequency ablation.…”

Fetal cardiac filling and ejection time fractions by pulsed‐wave Doppler: reference ranges and potential clinical application

“…FTF and ETF are promising, but insufficiently studied, parameters for the evaluation of fetal cardiac function [11][12][13][14]16 . The findings of this study demonstrate the feasibility and reproducibility of FTF and ETF measurements using pulsed-wave Doppler.…”

“…However, reference ranges for this parameter are not available. On the other hand, previous studies have demonstrated the utility of assessing ejection time in some pathologies 15,16 , but the feasibility and potential clinical utility of ejection time as a proportion of cycle time (ejection time fraction (ETF)) has not been evaluated. Accordingly, the objectives of this study were: (1) to evaluate the feasibility and reproducibility of fetal FTF and ETF measurements using pulsed-wave Doppler; (2) to evaluate their relationship with HR, gestational age (GA) and estimated fetal weight (EFW); (3) to provide reference ranges for fetal FTF and ETF; and (4) to evaluate their potential clinical utility in selected fetal conditions.…”

“…However, reference ranges for this parameter are not available. On the other hand, previous studies have demonstrated the utility of assessing ejection time in some pathologies 15,16 , but the feasibility and potential clinical utility of ejection time as a proportion of cycle time (ejection time fraction (ETF)) has not been evaluated.…”

“…LV-FTF (%)16.42995632288723 + (3617.924450406454/HR)6.432068875340649 -(90.01780352881514522 × HR) RV-FTF (%) 18.73327596623064 + (2889.916516631465/HR) 6.148098683328987 -(0.0182699393831315 × HR) LV-ETF (%) 29.692919 + (0.108611 × HR) -(0.139257 × GA) 2.365145 RV-ETF (%) 26.748934 + (0.124522 × HR) -(0.080492 × GA) 2.6371 GA, gestational age in weeks; HR, heart rate in bpm.…”