Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end‐diastolic umbilical artery flow

Gratacós, Eduard; Carreras, Elena; Becker, Jorge; Lewi, Liesbeth; Enríquez, Goya; Perapoch, Josep; Higueras, Teresa; Cabero, L.; Deprest, Jan

doi:10.1002/uog.1105

Cited by 161 publications

(164 citation statements)

References 19 publications

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“…An important factor, which may strongly influence the rate of cerebral injury, is gestational age at delivery. In the cohort from Gratacos et al, mean gestational age at delivery was lower (30.7 weeks' gestation) (Gratacos et al, 2004) than in our cohort and in the study from Chang et al (33.2 and 33.4 weeks' gestation, respectively) (Chang et al, 2010). Lower gestational age rather than sIUGR or Doppler flow patterns may account for the discrepancy in results between the studies.…”

Section: Discussioncontrasting

confidence: 76%

Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin

et al. 2012

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Fetal growth restriction in singletons has been shown to enhance fetal lung maturation and reduce the risk of respiratory distress syndrome due to increased endogenous steroid production. However, data on lung maturation in growth-discordant monochorionic (thus, identical) twins are lacking. Our objective was to compare the risk of severe neonatal morbidity between the larger and the smaller twin in monochorionic twins with birth weight discordance (BWD). We included in the study all consecutive monochorionic diamniotic pregnancies with severe BWD (≥25%) and two live-born twins delivered at our center (n = 47 twin pairs). We compared the incidence of neonatal morbidity, particularly respiratory distress syndrome (RDS), and cerebral lesions between the larger and the smaller co-twin. The incidence of severe neonatal morbidity in the larger and smaller twin was 38% (18/47) and 19% (9/47), respectively (odds ratio (OR) 2.66, 95% confidence interval (CI) 0.94-7.44) and was due primarily to the higher incidence of RDS, 32% (15/47) and 6% (3/47), respectively (OR 6.88, 95% CI 1.66-32.83). In conclusion, this study shows that the larger twin in monochorionic twin pairs with BWD is at increased risk of severe neonatal morbidity, particularly RDS, compared to the smaller twin.

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Section: Discussioncontrasting

confidence: 76%

Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin

et al. 2012

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“…Selective intra-uterine growth restriction (sIUGR) and twin-to-twin transfusion syndrome (TTTS) complicate monochorionic (MC) twin pregnancies, and are associated with a high risk of intra-uterine demise and neurological adverse outcome (Adegbite et al, 2004(Adegbite et al, , 2005Gratacos et al, 2004;Sebire et al, 1997;Victoria et al, 2001). Natural history of sIUGR in MC twin pregnancies is different to that in dichorionic (DC) twins and singletons because of the presence of placental anastomoses (Denbow et al, 2000).…”

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confidence: 99%

Application of Umbilical Artery Classification in Complicated Monochorionic Twins

et al. 2015

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We report our experience on the application of Gratacos' classification in a cohort of monochorionic pregnancies complicated by selective intra-uterine growth retardation based on the Doppler assessment of the umbilical artery. Materials and methods: A retrospective study was conducted on 52 cases of monochorionic twin pregnancies, in which one twin presented an abdominal circumference at or below the 10th percentile for gestational age. Cases were classified into three types according to the umbilical artery Doppler in the smaller twin. Subsequently, patients were divided into two groups: the selective IntraUterine Growth Retardation group and the Twin-to-Twin Transfusion Syndrome (TTTS) group. Results: Of the total 52 cases, 37 were classified as Type I, 12 as Type II, and 3 as Type III cases. In the total group, progressive fetal deterioration of the smaller fetus requiring active management was observed in 66.7% of Type II and 11.1% of Type I cases (p < .001), and in no Type III case. Unexpected fetal death of the smaller twin was observed more frequently in Type III (two cases, 66.7%) than in Types I and II cases (5% and 33%, respectively). Among the 52 cases, TTTS with oligo-polyhydramnios sequence was diagnosed in 10 cases. The remaining 42 cases were therefore defined as selective intra-uterine growth retardation. In the selective IntraUterine Growth Retardation group, results were similar to those obtained for the whole population. Conclusions: Classification of complicated monochorionic twins based on the umbilical artery Doppler is particularly important for counseling, even when we include TTTS cases, and permits the prediction of clinical evolution and perinatal outcome.

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“…Doppler flow velocimetry has been found a good method in examining the status and path of blood flow in fetal circulation [18] D. Previously, color Doppler ultrasonography has been used with success in examining the fetal circulation in terms of pathologic conditions such as intrauterine growth abnormalities, fetal anemia, and twin-to-twin transfusion syndrome [19][20][21][22]. However, its use, as a modality to determine the prognosis of twin or multiple pregnancies on the basis of chorionicity has been rarely studies [23,24]. For example, in a study by Fichera et al [25], the sensitivity and specificity of this method were 75% and 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Zuckerwise et al [27] also concluded that in monochorionic twin pregnancies with fetal growth retardation, color Doppler ultrasonographic findings might be abnormal. On the other hand, it has been shown that in uncomplicated monochorionic pregnancies before the week 28, color Doppler ultrasonographic findings might be abnormal [28] and single abnormal findings may indicate the presence of certain placental anastomosis and not essentially a hazardous, unfavorable condition [4,10,23]. So, it is important to include abnormal twin pregnancies in terms of neonatal-fetal abnormalities in future studies.…”

Section: Discussionmentioning

confidence: 99%

The Role of Second and Third Trimester Umbilical Artery Doppler Ultrasonography in Determining Chorionicity of Twin Pregnancies

Samani

Ghasemzadeh²,

Mousavi

2016

AJLSR

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Introduction: Determining the chorionicity in monozygotic twins is of pivotal importance, because it has been shown that monochorionic fetuses compared to dichorionic counterparts bear a higher risk f morbidity and mortality. Using conventional ultrasonography in this regard is along with accurate results provided that it is conducted before 14 weeks' gestation. It has been suggested that differences between color Doppler ultrasonographic indices obtained from the umbilical arteries of twins may result in the prediction of chorionicity. Nevertheless, relevant available data are very scarce. This study aimed to examine the role of umbilical artery Doppler ultrasound in the second and third trimesters in determining chorionicity in twin pregnancies Methods: A total 20 monochorionic monozygotic pregnancies and 30 dichorionic monozygotic pregnancies between 28 and 39 weeks' gestation were examined by color Doppler study of the umbilical arteries. The pulsatility index (PI), resistive index (RI) and the S to D ratio (S/D) of the umbilical arteries and their differences in each group independently were compared between twins. Results: The mean PI difference between the two umbilical arteries did not differ significantly between the two groups; however, the mean differences of RI and S/D were significantly higher in the dichorionic group (0.006 ± 0.01 vs. 0.04 ± 0.01, P = 0.02, and 0.54 ± 0.09 vs. 0.33 ± 0.05, P = 0.04, respectively). When the difference between the two fetuses in terms of the umbilical artery RI difference exceeded 0.05 and over, the probability of dichorionic pregnancy was present (sensitivity, 60% and specificity, 65%). The difference of S/D was not acceptable as to the diagnostic accuracy in this regard. Conclusions: On the basis of our findings, the results of umbilical artery color Doppler study in twin pregnancies aged 28-39 weeks' gestation could be used for determining chorionicity. To reach more solid conclusions, further studies with larger sample sizes are recommended to be carried out.

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Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end‐diastolic umbilical artery flow

Cited by 161 publications

References 19 publications

Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin

Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin

Application of Umbilical Artery Classification in Complicated Monochorionic Twins

The Role of Second and Third Trimester Umbilical Artery Doppler Ultrasonography in Determining Chorionicity of Twin Pregnancies

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