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Application of Umbilical Artery Classification in Complicated Monochorionic Twins

  • Lucia Pasquini (a1), Silvia Conticini (a1), Tiziana Tomaiuolo (a1), Giovanni Sisti (a1), Viola Seravalli (a1), Carlo Dani (a1) and Mariarosaria Di Tommaso (a1)...

Abstract

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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Copyright

Corresponding author

address for correspondence: Lucia Pasquini, Department of Maternal and Child Health, University of Florence, Largo Brambilla 3, 50134 Florence, Italy. E-mail: luciapasquini@tin.it

References

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Adegbite, A. L., Castille, S., Ward, S., & Bajoria, R. (2004). Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight. American Journal of Obstetrics and Gynecology, 190, 156163.
Adegbite, A. L., Castille, S., Ward, S., & Bajoria, R. (2005). Prevalence of cranial scan abnormalities in preterm twins in relation to chorionicity and discordant birth weight. European Journal of Obstetrics & Gynecology and Reproductive Biology, 119, 4755.
Arduini, D., Rizzo, G., & Romanini, C. (1993). The development of abnormal heart rate patterns after absent end-diastolic velocity in umbilical artery: Analysis of risk factors. American Journal of Obstetrics and Gynecology, 168, 4350.
Denbow, M. L., Cox, P., Taylor, M., Hammal, D. M., & Fisk, N. M. (2000). Placental angioarchitecture in monochorionic twin pregnancies: Relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. American Journal of Obstetrics and Gynecology, 182, 417426.
Gratacos, E., Carreras, E., Becker, J., Lewi, L., Enriquez, G., Perapoch, J., . . . Deprest, J. (2004). Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic umbilical artery flow. Ultrasound in Obstetrics and Gynecology, 24, 159163.
Gratacos, E., Lewi, L., Munoz, B., Acosta-Rojas, R., Hernandez-Andrade, E., Martinez, J. M., . . . Deprest, J. (2007). A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound in Obstetrics and Gynecology, 30, 2834.
Ishii, K., Murakoshi, T., Takahashi, Y., Shinno, T., Matsushita, M., Naruse, H., . . . Nakata, M. (2009). Perinatal outcome of monochorionic twins with selective intrauterine growth restriction and different types of umbilical artery Doppler under expectant management. Fetal Diagnosis and Therapy, 26, 157161.
Mari, G., Deter, R. L., Carpenter, R. L., Rahman, F., Zimmerman, R., Moise, K. J. Jr., . . . Blackwell, S. C. (2000). Non-invasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. New England Journal of Medicine, 342, 914.
Sebire, N. J., Snijders, R. J., Hughes, K., Sepulveda, W., & Nicolaides, K. H. (1997). The hidden mortality of monochorionic twin pregnancies. British Journal of Obstetrics and Gynaecology, 104, 12031207.
Slaghekke, F., Kist, W. J., Oepkes, D., Pasman, S. A., Middeldorp, J. M., Klumper, F. J., . . . Lopriore, E. (2010). Twin anemia-polycythemia sequence: Diagnostic criteria, classification, perinatal management and outcome. Fetal Diagnosis and Therapy, 27, 181190.
Vanderheyden, T. M., Fichera, A., Pasquini, L., Tan, T. Y., Wee, L. Y., Frusca, T., . . . Fisk, N. M. (2005). Increased latency of absent end-diastolic flow in the umbilical artery of monochorionic twin fetuses. Ultrasound in Obstetrics and Gynecology, 26, 4449.
Victoria, A., Mora, G., & Arias, F. (2001). Perinatal outcome, placental pathology, and severity of discordance in monochorionic and dichorionic twins. Obstetrics & Gynecology, 97, 310315.
Wee, L. Y., Taylor, M. J., Vanderheyden, T., Talbert, D., & Fisk, N. M. (2003). Transmitted arterio-arterial anastomosis waveforms causing cyclically intermittent absent/reversed end-diastolic umbilical artery flow in monochorionic twins. Placenta, 24, 772778.
Yu, C. K., Papageorghiou, A. T., Boli, A., Cacho, A. M., & Nicolaides, K. H. (2002). Screening for pre-eclampsia and fetal growth restriction in twin pregnancies at 23 weeks of gestation by transvaginal uterine artery Doppler. Ultrasound in Obstetrics and Gynecology, 20, 535540.

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