Obstet Gynecol Sci.  2015 Jan;58(1):17-23. 10.5468/ogs.2015.58.1.17.

Doppler assessment of fetal aortic isthmus flow in twin

Affiliations
  • 1Department of Obstetrics and Gynecolgy, Gachon University Gil Medical Center, Incheon, Korea. ksyob@ghil.com

Abstract


OBJECTIVE
The purpose of this study was to investigate the aortic isthmus (AoI) flow difference between larger fetus and smaller fetus of twin; and to evaluate the predictive value of early diagnosis of hemodynamic change in twin growth.
METHODS
This prospective study on 49 pairs of twin fetuses was performed to obtain AoI blood flow data. Cases with structural or chromosomal abnormalities and co-twin death were excluded. The interval from examination to delivery was within 4 weeks and 3 cases over 4 weeks interval were re-examined. Assessment of fetal AoI Doppler parameters were peak systolic velocity (PSV), end-diastolic velocity, times-averaged maximum velocities, pulsatility index (PI), and resistance index (RI). According to the direction of the diastolic flow in the AoI, antegrade and retrograde flow were made and was used to analyze the perinatal outcomes of each fetus. The predictive value of AoI Doppler parameters in predicting fetal growth was obtained by using ANOVA and logistic regression analysis of quantitative variables in each fetus of twins.
RESULTS
There were significant differences in the gestational weeks at delivery, birth weight and the incidence of growth discordance over 20% or more between monochorionic twin and dichorionic twin. The AoI PI and RI were significantly higher in smaller fetus than in larger regardless of chorionicity. Retrograde flow was noted in 8 of 98 cases (8.2%) and the only one case was of the larger fetus and the others were smaller fetuses of twin. Significant correlations were found between the AoI PI and birthweight (P=0.018) and between the PSV and growth discordance (P=0.032). In monochorionic twin, linear correlation was shown between the AoI PI and birthweight (P=0.004) and between AoI PI and growth discordance (P=0.031). Also, the meaningful correlation between the PSV and birthweight (P=0.036) was found by using logistic regression analyses.
CONCLUSION
On the basis of our observation, AoI PI has revealed their hemodynamic status and this result may improve the understanding of growth patterns in twins.

Keyword

Aortic isthmus; Chorionicity; Doppler; Growth discordance; Twins

MeSH Terms

Birth Weight
Chorion
Chromosome Aberrations
Early Diagnosis
Fetal Development
Fetus
Hemodynamics
Humans
Incidence
Logistic Models
Prospective Studies
Twins*

Figure

  • Fig. 1 Ultrasonographic images of aortic isthmus.

  • Fig. 2 The correlation between peak systolic velocity and birth-weight in monochorionic twin.

  • Fig. 3 The correlation between aortic isthmus pulsatility index (Aol PI) and birthweight in monochorionic twin.

  • Fig. 4 The correlation between aortic isthmus pulsatility index (Aol PI) and growth discordance in monochorionic twin.


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