Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Abstract

This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin-estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.

Maternal Utero-Placental Perfusion Discordance in Monochorionic-Diamniotic Twin Pregnancies with Selective Growth Restriction Assessed by Three-Dimensional Power Doppler Ultrasound

“…sGR has been showed to be closely associated with impaired utero-placental perfusion [5,6]. For the non-invasive approach, previous studies evaluating utero-placental perfusion have used conventional Doppler ultrasound [6,7] to assess the umbilical artery and middle cerebral artery velocimetries. Since only severe fetal hypoxemia would result in classical abnormal Doppler velocity waveforms, mildly impaired perfusion prior to the onset of fetal compromise might not be determined in a timely manner [8].…”

Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study

“…Ultrasound examination serves as a routine method for predicting sIUGR. Previous studies have shown that the evaluation of utero-placental perfusion indices, including umbilical artery and middle cerebral artery velocimetry using Doppler ultrasound, have good efficacy for sIUGR prediction (9)(10)(11)(12)(13)(14). Additionally, magnetic resonance imaging (MRI) of placental invasion has recently become part of clinical practice (15); however, the major disadvantages of MRI include expensive devices and relatively complex techniques.…”

Increased autophagy in the placental territory of selective intrauterine growth‐restricted monochorionic twins

“…Autophagic activity is upregulated by starvation, growth factor deprivation, and hypoxia . In monochorionic twin (MC) pregnancies with selective intrauterine growth restriction (sIUGR), the umbilical blood flow perfusion to the sIUGR twin is significantly decreased versus that to the appropriate‐for‐gestational age (AGA) cotwin . This poor perfusion condition is similar to starvation, growth factor deprivation, or hypoxia.…”