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Ultrasound in the Diagnosis of Twin-to-Twin Transfusion Syndrome – a Preliminary Report

Published online by Cambridge University Press:  01 August 2014

M. Ropacka ,
W. Markwitz ,
W. Ginda  and
G. H. Bręborowicz
M. Ropacka*
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
W. Markwitz
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
W. Ginda
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
G. H. Bręborowicz
Affiliation:
Department of Perinatology and Gynecology, University School of Medical Sciences, Poznan, Poland
*
Klinika Perinatologii i Ginekologii, Ginekologiczno-Położniczy Szpital Kliniczny Akademii Medycznej, 60-535 Poznań, ul. Polna 33, Polska

Abstract

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Objective. The aim of this study was to show the diagnostic possibilities of ultrasound in twin-to-twin transfusion syndrome (TTTS), to demonstrate its usefulness in cases of hemoglobin difference < 5 g/dL in neonates as well as in cases complicated by intrauterine death of one or both twins.

Study design. The study included 4 pairs of twins. In two cases 3 fetuses died in utero. In the other two the hemoglobin difference in newborn infants was < 5 g/dL. The ultrasound examination, evaluating the fetal anatomy and biometry, amniotic fluid volume, placentation, was performed. The special attention was paid to polyhydramnios/oligohydramnios, discordant fetal growth (fetal weight, abdominal circumference), the presence of fetal hydrops, ascites, pericardial effusion. Doppler blood flow velocimetry has been done in umbilical vessels, middle cerebral artery. The data was compared with normal reference values for singleton pregnancies. The waveforms from both uterine arteries were also evaluated to exclude placental insufficiency. Additionally the blood flow through the AV valves was measured to exclude or confirm its regurgitation. Postnatally the hemoglobin difference was evaluated if available and compared with sonographic findings.

Results. In all cases inter-twin difference in abdominal circumference was greater than 18 mm and inter-twin weight difference of more than 15%. We observed polyhydramnios/oligohydramnios in all twin pregnancies.

It has been found decreased PI in middle cerebral artery in larger fetus (recipient) in all our cases (comparing to single pregnancy). PI values for this vessel in smaller fetuses were within normal range (for single pregnancy). PI values in umbilical arteries of recipients were abnormal (increased PI or absent end-diastolic flow).

Comments. The sonographic criteria seem to be very useful in diagnosis of twin-to-twin transfusion syndrome, especially in cases where the measurement of hemoglobin level is impossible. Doppler blood flow velocimetry in fetal vessels helps to explain the changes in fetal hemodynamics in TTTS.

Keywords

Twin-to-twin transfusion (TTTS) syndromePrenatal ultrasoundDoppler blood flow velocimetry
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 47 , Issue 3-4 , October 1998 , pp. 227 - 237
Copyright
Copyright © The International Society for Twin Studies 1998

References

REFERENCES

1. Abraham, JM (1967): Intrauterine feto-fetal transfusion syndrome. Clinical observation and speculation on pathogenesis. Clin Pediatr 6: 405–10.CrossRefGoogle Scholar
2. Achiron, R, Rosen, N, Zakut, H (1987): Patophysiologic mechanism of hydramnios development in twin transfusion syndrome. A case report. J Reprod Med 32: 305–8.Google Scholar
3. Arabin, B, Jimenez, E, Saling, E (1987): Die Bedeutung von Doppler-Blutflussmessung bei Geminigraviditat. Z Geburtsh Perinat 191: 99–104.Google Scholar
4. Bebbington, MW, Wittmann, BK (1989): Fetal transfusion syndrome: antenatal factors predicting fetal outcome. Am J Obstet Gynecol 160: 913–15.CrossRefGoogle Scholar
5. Bernischke, K (1961): Twin placenta in perinatal mortality. NY State J Med 61: 1499–508.Google Scholar
6. Benirschke, K, Chung, KK (1973): Multiple pregnancy. New Engl Med J 288: 1276–84.CrossRefGoogle ScholarPubMed
7. Blickstein, I (1990): The twin-twin transfusion syndrome. Obstet Gynecol 76: 714–21.Google ScholarPubMed
8. Blickstein, I, Friedman, A, Caspi, B, Lancet, M (1989): Ultrasonic prediction of growth discordance by intertwin difference in abdominal circumference. Int J Gynecol Obstet 29: 121–4.CrossRefGoogle ScholarPubMed
9. Brennan, JN, Divan, RV, Rosen, MG, Bellon, EM (1982): Fetofetal transfusion syndrome: Prenatal ultrasonographic diagnosis. Radiology 143: 535–6.CrossRefGoogle ScholarPubMed
10. Brown, DL, Benson, CB, Driscoll, SG, Doubilet, PM (1989): Twin-twin transfusion syndrome: Sonographic findings. Radiology 170: 61–3.CrossRefGoogle ScholarPubMed
11. Campbell, S, Wladimiroff, JW, Dewhurst, DI (1973): The antenatal measurement of fetal urinary production. J Obstet Gynaecol Br Commonw 80: 680–6.CrossRefGoogle Scholar
12. Chescheir, NC, Seeds, JW (1988): Polyhydramnios and oligohydramnios in twin gestation. Obstet Gynecol 71: 882–4.Google Scholar
13. Danskin, FH, Neilson, JP (1989): Twin-to-twin transfusion syndrome: What are appropriate diagnostic criteria? A J Obstet Gynecol 161: 365–9.CrossRefGoogle ScholarPubMed
14. Farmakides, G, Schulman, H, Saldana, LR, Bracero, LA, Fleischer, A, Rochelson, B (1985): Surveillance of twin pregnancy with umbilical velocimetry. Am J Obstet Gynecol 153: 789–92.CrossRefGoogle Scholar
15. Fries, MH, Goldstein, RB, Kilpatrick, SJ (1993): The role of velamentous cord insertion in the etiology of twin-twin transfusion syndrome. Obstet Gynecol 81: 569–74.Google ScholarPubMed
16. Gembruch, U, Arabin, B (1994): Twin to twin transfusion syndrome. In: van Geijn, HP, Copray, FJA (Ed): A critical appraisal of fetal surveillance. Elsevier Science BA, chapter 22: 169–79.Google Scholar
17. Gembruch, U, Redel, DA, Bald, R, Hansman, M (1993): Longitudinal study in 18 cases of fetal supraventricular tachycardia: Doppler echocardiographic findings and pathophysiologic implications. Am Heart J 125: 1290–1301.CrossRefGoogle ScholarPubMed
18. Giles, WB, Trudinger, B, Cook, CM (1985): Fetal umbilical artery flow velocity-time wave forms in twin pregnancy. Br J Obstet Gynaecol 92: 490–97.CrossRefGoogle Scholar
19. Giles, WB, Trudinger, BJ, Cook, CM, Connelly, A (1988): Umbilical artery flow velocity wave forms and twin pregnancy outcome. Obstet Gynecol 72: 984–97.CrossRefGoogle Scholar
20. Giles, WB, Trudinger, BJ, Cook, CM (1990): Doppler umbilical artery studies in twin-twin transfusion syndrome. Obstet Gynecol 76: 1097–1102.Google ScholarPubMed
21. Hecher, K, Ville, Y, Nicolaides, KH (1995): Fetal arterial Doppler studies in twin-twin transfusion syndrome. J Ultrasound Med 14: 101–108.CrossRefGoogle ScholarPubMed
22. Kirshon, B (1989): Fetal urine output in hydramnios. Obstet Gynecol 73: 240–2.Google ScholarPubMed
23. Klebe, JG, Ingomar, CJ (1972): The fetoplacental circulation during parturition illustrated by the interfetal transfusion syndrome. Pediatrics 49: 112–6.CrossRefGoogle ScholarPubMed
24. Nimrod, C, Davies, D, Harder, J, Dempster, C, Dodd, G, Mcdicken, N, Nicholson, S (1987): Doppler ultrasound prediction of fetal outcome in twin pregnancies. Am J Obstet Gynecol 156: 402–06.CrossRefGoogle ScholarPubMed
25. Rausen, AR, Seki, M, Strauss, L (1965): Twin transfusion syndrome. J Pediatr 66: 613–28.CrossRefGoogle ScholarPubMed
26. Robertson, EG, Neer, KJ (1983): Placental injection studies in twin gestation. Am J Obstet Gynecol 147: 170–4.CrossRefGoogle ScholarPubMed
27. Saldana, LR, Eads, MC, Schaefer, TR (1985): Umbilical blood wave forms in fetal surveillance of twins. Am J Obstet Gynecol 153: 789–92.Google Scholar
28. Saunders, NJ, Snijders, RJM, Nicolaides, KH (1991): Twin-twin transfusion syndrome in the second trimester is associated with small intertwin hemoglobin differences. Fetal Diagn Ther 6: 34–7.CrossRefGoogle Scholar
29. Saunders, NJ, Snijders, RJM, Nicolaides, KH (1992): Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy. Am J Obstet Gynecol 166: 820–6.CrossRefGoogle ScholarPubMed
30. Schinzel, AA, Smith, DW, Miller, JR (1979): Monozygotic twinning and structural defects. J Pediatr 95: 921–30.CrossRefGoogle ScholarPubMed
31. Storlazzi, E, Vintzileos, AM, Campbell, WA, Nochimson, DJ, Weinbaum, PJ (1987): Ultrasonic diagnosis of discordant fetal growth in twin gestations. Obstet Gynecol 69: 363–7.Google ScholarPubMed
32. Tan, KL, Tan, R, Tan, SH, Tan, AM (1979): The twin transfusion syndrome. Clin Pediatr 18: 114–4.CrossRefGoogle ScholarPubMed
33. Wittmann, BK, Baldwin, VJ, Nichol, B (1981): Antenatal diagnosis of twin transfusion syndrome by ultrasound. Obstet Gynecol 58: 123–6.Google ScholarPubMed
34. Yamada, A, Kasugai, M Ohno, (1991): Antenatal diagnosis of twin-twin transfusion syndrome by Doppler ultrasound. Obstet Gynecol 78: 1058–61.Google ScholarPubMed