Doppler flow velocity waveforms in fetal surveillance of twins: a prospective longitudinal study

Abstract

In 37 consecutive twin pregnancies, monthly Doppler sonographic measurements were made of blood flow velocity waveforms of the internal carotid and umbilical artery of each fetus. A total of 197 Doppler studies were performed. Of the 74 infants, 23 were small for gestational age (SGA). Thirty-five of the SGA Doppler studies were abnormal, giving an overall sensitivity for predicting SGA fetus of 58% and a positive predictive value of 71%. These data are not as sensitive and specific as our earlier data; however, Doppler criteria preceded sonographic diagnosis of SGA by a mean interval of 3.7 weeks and demonstrated better sensitivity and specificity. A combination of these parameters improves sensitivity to 84%. We conclude that Doppler velocimetry complements real-time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies.

Fetal Cerebrovascular Circulation: A Review of Prenatal Ultrasound Assessment

“…Others [34] attributed the low PI values at the beginning and end of pregnancy to increased metabolic requirements and, therefore, lower cerebral vascular impedance to blood flow. Doppler flow studies in twins without growth retardation or discordance demonstrated changes throughout pregnancy similar to those in singletons [35] .…”

“…A combination of systemic and cerebral Doppler parameters may complement real-time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies [35] . Different trends in Doppler serial recordings were found according to the underlying mechanism of growth defect.…”

Umbilical and fetal middle cerebral artery Doppler reference ranges in a twin population followed longitudinally from 24 to 38 weeks' gestation

“…Umbilical artery (UA) Doppler ultrasonography is an important tool in the assessment of high‐risk pregnancies, in particular singleton pregnancies affected by vasculopathy and growth restriction, but also in twin pregnancies affected by placental insufficiency. A meta‐analysis of randomized controlled trials of UA Doppler indices in high‐risk pregnancies showed that clinical actions guided by Doppler ultrasound reduced the odds of perinatal death by 38%.…”

ACR Appropriateness Criteria® Multiple Gestations

“…63,64 As such, it has prognostic significance for the likelihood of growth restriction and perinatal morbidity and mortality, and it may change weekly if abnormal. 65 The values and patterns of change in vascular resistance are the same as for singletons. 66 Doppler assessment of umbilical venous blood flow and umbilical artery systolic/diastolic ratios are considered useful in predicting and confirming concordant and discordant growth in twins.…”