Umbilical Artery Waveforms in Triplet and Quadruplet Pregnancies

Abstract

The incidence of abnormal umbilical waveforms in triplet and quadruplet pregnancies and its correlation with adverse pregnancy outcome was studied by a retrospective review of all our triplet and quadruplet pregnancies (1986–1993) with documented Doppler flow assessment. Obstetrical outcomes were analyzed in relation to abnormal umbilical artery waveforms. Nineteen triplet and 4 quadruplet pregnancies were studied. Of 73 fetuses, 6 had abnormal umbilical artery waveforms (8.2%). All abnormal waveforms were characterized by persistent absence of the end-diastolic velocities (AEDV). In comparing the abnormal and normal groups, significant differences were found in birth weights (910 ± 433 vs. 1,724±434 g; p = 0.0004), small for gestational age rate [5/6 (83%) vs. 5/67 (7.5%); p = 0.0003], and perinatal mortality rate [3/6 (50%) vs. 2/67(3%); p = 0.001]. There were no differences in congenital anomalies, gestational age at birth, and neonatal intensive care admission. In conclusion, it seems that Doppler umbilical artery waveforms in multiple pregnancies were either normal or extremely abnormal (e.g. AEDV). AEDV was associated with adverse perinatal outcomes such as low birth weight, growth restriction and perinatal mortality.

Management of Multiple Pregnancy: Prenatal Care???Part I

“…The positive predictive value of an abnormal Doppler outcome was 90%, and the negative predictive value was 95.6% (63). Furthermore, the finding of absent end diastolic velocities on Doppler umbilical waveforms in triplet and quadruplet pregnancies is associated with adverse perinatal outcomes such as low birth weight, growth restriction, and perinatal mortality (64).…”

Mean Arterial Pressure in Concordant and Discordant Triplets during the First Week of Life

“…Large discordant VLBW twins without twin-twin transfusion who are appropriate for GA are expected to be in utero hemodynamically comparable to normal singletons. [32][33][34] Thus, it is not surprising that concordant and large discordant triplets have similar MAP values and trends postnatally.…”

ACR Appropriateness Criteria® Multiple Gestations

“…Absent end diastolic flow is associated with low birth weight, growth restriction, and perinatal mortality in triplet and quadruplet pregnancies. 67,68 On each indicated follow-up sonogram, it remains equally important to continue to measure twins for development of new or progressive discordance, and to evaluate the cervix and each twin's amniotic fluid. Transvaginal sonography has been shown to be able to accurately assess cervical length and predict spontaneous delivery before 34 weeks as early as the 23rd week.…”