Transmitted Arterio-arterial Anastomosis Waveforms Causing Cyclically Intermittent Absent/Reversed End-diastolic Umbilical Artery Flow in Monochorionic Twins

Wee, L.; Taylor, M. J. O.; Vanderheyden, T.; Talbert, D.G.; Fisk, Nicholas M.

doi:10.1016/s0143-4004(03)00114-0

Cited by 74 publications

(81 citation statements)

References 12 publications

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“…This variation was initially attributed to the presence of an arterioarterial anastomosis, which has been shown to cause UA Doppler fluctuations. 10 Another possible explanation for this finding was the random sampling of the as yet unrecognized discordant donor UAs. This had important implications for counseling and management because the Doppler findings suggested worsening of the TTTS, and the patient was reclassified from a Quintero stage 1 to a Quintero stage 3 atypical donor.…”

Section: Discussionmentioning

confidence: 99%

Umbilical Artery Hypoplasia in Twin‐Twin Transfusion Syndrome Complicated by Discordant Umbilical Artery Doppler Findings in the Donor Twin

Pathak

Benirschke

Chmait

2009

J of Ultrasound Medicine

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etal Doppler assessment is a useful tool in diagnosing and staging monochorionic twins complicated by twin-twin transfusion syndrome (TTTS). 1Umbilical artery absent or reversed end-diastolic velocity (UA-AREDV) is a poor prognostic factor in TTTS 2,3 and is associated with increased risk of in utero fetal death of the donor twin. 4 The etiology of donor twin UA-AREDV has primarily been attributed to 2 placental factors: unequal individual placental territories and the presence of arterioarterial anastomoses.5 However, umbilical artery (UA) hypoplasia, which can result in UA-AREDV, has not to our knowledge been reported in association with TTTS. We present a case with donor twin umbilical artery absent enddiastolic velocity (UA-AEDV) caused by a hypoplastic UA, with emphasis on the diagnostic and management challenges associated with discordant UA Doppler findings in the setting of TTTS. Case ReportIn vitro fertilization with assisted hatching and implantation of 3 embryos resulted in a monochorionic diamniotic twin gestation in a 31-year-old primiparous woman. At 15 weeks 3 days, sonographic findings for twin B were notable for a maximum vertical amniotic fluid pocket (MVP) of 1 cm and persistent AEDV identified in a UA. However, repeat Doppler examinations performed at 16 weeks 6 days and 18 weeks showed normal UA diastolic flow. Umbilical artery AEDV was identified again in twin B at 18 weeks 2 days, at which time a diagnosis of Quintero stage 3 atypical donor TTTS was made. 1 Twin A, the recipient twin, had an estimated fetal weight of 281 g with an MVP of 9.7 cm. Twin B, the donor, weighed 234 g, accounting for a 17% growth discordance, with an MVP of 1.0 cm. A small bladder was visible in twin B. Aside from

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Section: Discussionmentioning

confidence: 99%

Umbilical Artery Hypoplasia in Twin‐Twin Transfusion Syndrome Complicated by Discordant Umbilical Artery Doppler Findings in the Donor Twin

Pathak

Benirschke

Chmait

2009

J of Ultrasound Medicine

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“…We recently completed a detailed study of 90 MC placentae where the frequency of velamentous cord insertion in TTTS was similar to that in non-TTTS MC controls (53% vs. 52% -Taylor et al 2 ). The phenomenon of cyclical end-diastolic frequencies in UA waveforms in MC twins has been described previously 3,4 . Our group has documented an association between cyclical interference patterns in the UA Doppler waveforms and arterio-arterial anastomosis (AAA), and verified their physiological basis by computer modeling.…”

Section: Variable Umbilical Artery End-diastolic Frequency Is Associamentioning

confidence: 91%

“…In our series, this cyclical pattern occurred in a fifth of growth restricted MC twins with an AAA detected in vivo, but never in their large/appropriately grown co-twins nor in MC twins without an AAA detected in vivo. We reproduced this pattern in a computer model by summing end-diastolic frequencies with a high pulsatility index in the UA in the presence of a large AAA 4 . Consistent with this, MC twins with a transmitted pattern had significantly larger AAAs than MC twins discordant for growth restriction without transmitted AAA waveforms.…”

Section: Variable Umbilical Artery End-diastolic Frequency Is Associamentioning

confidence: 98%

“…This interference pattern cycles through present, then absent and often reversed end-diastolic frequencies before end-diastolic frequencies return ( Figure 1). The periodicity of the cyclical pattern is equal to the period of the AAA, which is a function of the difference in two fetal heart rates 4 . In our series, this cyclical pattern occurred in a fifth of growth restricted MC twins with an AAA detected in vivo, but never in their large/appropriately grown co-twins nor in MC twins without an AAA detected in vivo.…”

Section: Variable Umbilical Artery End-diastolic Frequency Is Associamentioning

confidence: 99%

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Sonography for the diagnosis of adenomyosis

Atzori¹

2003

Ultrasound in Obstet & Gyne

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“…(Tomado de Valsky et al) 13 Este tipo de señal Doppler no es patognomónica de gestaciones MC con RCIUs. Ocasionalmente pueden observarse en gestaciones MC sin complicaciones (cuando las inserciones de los cordones están muy próximos y hay grandes anastomosis AA) e incluso en embarazos complicados con STFF 57 . El rasgo característico del patrón Doppler, es la alternancia de fases positivas del flujo de fin de diástole con fases del flujo diastólico ausente / inverso, normalmente, pero no siempre de manera cíclica.…”

Section: Tipo IIIunclassified

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Cosp

2016

Rev. Nac. (Itauguá)

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RESUMENLa Restricción Selectiva del Crecimiento Intrauterino se produce en 10 a 19% de los gemelos monocoriónicos y se asocia con un aumento importante de la mortalidad y la morbilidad perinatal. La evolución clínica está dada en gran parte por la presencia de anastomosis vaculares y la distribución placentaria asimétrica. Se propuso una clasificación en tres tipos según el Doppler de la arteria umbilical del gemelo más pequeño, la que sé que se correlaciona con distintos comportamientos clínicos y características de la placenta, lo que ayuda en el asesoramiento y conducta obstétrica. Los del tipo I tienen un pronóstico favorable por el resultado perinatal satisfactorio por lo que se recomienda un seguimiento cercano por ecografía y Doppler. Los de tipo II tienen un mal pronóstico y el tipo III un pronóstico intermedio e impredecible. En estos dos últimos se puede realizar un manejo expectante hasta que se observe deterioro del feto pequeño, considerando la posibilidad de la coagulación con láser o la oclusión del cordón (feticidio selectivo). Ambas conductas aparentemente aumentan las posibilidades de supervivencia del feto de peso normal.Palabras claves: restricción selectiva del crecimiento intrauterino, diagnóstico, manejo, gemelos monocoriales, doppler, terapia fetal ABSTRACT Selective intrauterine growth restriction occurs in 10-19% of monochorionic twins and is associated with increased mortality important and perinatal morbidity. The clinical course is given largely by the presence of placental vascular anastomosis and asymmetric distribution. It classified into three types according to the proposed Doppler umbilical artery smaller twin, the one that correlates with different clinical behaviors and characteristics of the placenta, which helps in counseling and obstetric conduct. The type I have a favorable prognosis for satisfactory perinatal outcome so closely monitored by ultrasound and Doppler is recommended. The type II has a poor prognosis and type III intermediate and unpredictable prognosis. In these last two you can make an expectant management until deterioration of the small fetus is observed, considering laser coagulation or cord occlusion(selective feticide). Both behaviors appear to increase the chances of survival of the fetus of normal weight.

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Transmitted Arterio-arterial Anastomosis Waveforms Causing Cyclically Intermittent Absent/Reversed End-diastolic Umbilical Artery Flow in Monochorionic Twins

Cited by 74 publications

References 12 publications

Umbilical Artery Hypoplasia in Twin‐Twin Transfusion Syndrome Complicated by Discordant Umbilical Artery Doppler Findings in the Donor Twin

Umbilical Artery Hypoplasia in Twin‐Twin Transfusion Syndrome Complicated by Discordant Umbilical Artery Doppler Findings in the Donor Twin

Sonography for the diagnosis of adenomyosis

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

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