Relevance of routine Doppler sampling at the two umbilical arteries in the follow-up of dichorionic twin pregnancies with intrauterine growth-restricted fetuses

A J Vivanti; E Lecarpentier; A-G Cordier; F Proulx; V Tsatsaris; A Benachi

doi:10.1016/j.jogoh.2016.10.008

Relevance of routine Doppler sampling at the two umbilical arteries in the follow-up of dichorionic twin pregnancies with intrauterine growth-restricted fetuses

J Gynecol Obstet Hum Reprod. 2017 Mar;46(3):285-289. doi: 10.1016/j.jogoh.2016.10.008. Epub 2017 Feb 7.

Authors

A J Vivanti¹, E Lecarpentier², A-G Cordier³, F Proulx⁴, V Tsatsaris⁴, A Benachi⁵

Affiliations

¹ Department of obstetrics and gynecology, hôpital Antoine-Béclère, université Paris Sud, Assistance publique des Hôpitaux de Paris, 92140 Clamart, France. Electronic address: alexvivanti@gmail.com.
² Obstetrics and gynecology unit, maternité Port-Royal, Paris Descartes University, AP-HP, 75014 Paris, France.
³ Department of obstetrics and gynecology, hôpital Antoine-Béclère, université Paris Sud, Assistance publique des Hôpitaux de Paris, 92140 Clamart, France.
⁴ Obstetrics and gynecology unit, maternité Port-Royal, Paris Descartes University, AP-HP, 75014 Paris, France; PremUp foundation (fondation pour la prévention de la prématurité et la protection du nouveau-né prématuré), 75014 Paris, France.
⁵ Department of obstetrics and gynecology, hôpital Antoine-Béclère, université Paris Sud, Assistance publique des Hôpitaux de Paris, 92140 Clamart, France; PremUp foundation (fondation pour la prévention de la prématurité et la protection du nouveau-né prématuré), 75014 Paris, France.

PMID: 28403927
DOI: 10.1016/j.jogoh.2016.10.008

Abstract

Objective: The aim of this study is to assess if the presence of bilateral absent or reverse end-diastolic velocity (AREDV) indicates a poorer prognosis than unilateral AREDV in dichorionic-diamniotic twin pregnancies complicated by intrauterine growth restriction.

Methods: A prospective observational study of 36 dichorionic-diamniotic twin pregnancies complicated by intrauterine growth restriction. One hundred and fifty seven ultrasound (US) examinations were performed. The pulsatility indexes (PI) of the two umbilical arteries (UA-perivesical site), the middle cerebral artery (MCA) and the ductus venosus (DV) were recorded. The fetal hemodynamic status was represented by the existence of a bilateral positive end-diastolic velocity (PEDV), a unilateral AREDV or a bilateral AREDV in the umbilical arteries.

Results: Bilateral PEDV, unilateral AREDV and bilateral AREDV represented respectively 66.0%, 10.6% and 23.4% of the US examinations. Intervals between Doppler examinations and delivery were significantly longer (P<0.005) in the bilateral PEDV group (26.5 days±19.7) than in the unilateral AREDV group (11.8 days±11.7) and in the bilateral AREDV group (11.0 days±8.6). MCA-PI, DV-PI, IFI and early neonatal outcomes did not differ between the unilateral and bilateral AREDV groups.

Conclusion: The routine measurement of the Doppler indices of the two umbilical arteries seems to be no more relevant than unilateral measurement in fetuses of dichorionic-diamniotic twin pregnancies complicated by intrauterine growth restriction.

Keywords: Dichorionic-diamniotic; Doppler ultrasound; Intrauterine growth restriction; Twin pregnancy; Umbilical artery.

Publication types

Observational Study

MeSH terms

Adult
Blood Flow Velocity / physiology
Female
Fetal Growth Retardation*
Follow-Up Studies
Humans
Middle Cerebral Artery / diagnostic imaging
Middle Cerebral Artery / physiology
Pregnancy
Pregnancy, Twin*
Prospective Studies
Pulsatile Flow / physiology
Ultrasonography, Doppler*
Umbilical Arteries / diagnostic imaging*
Umbilical Arteries / physiology