TY - JOUR
T1 - Short-Term Flow Changes in Monochorionic Survivor Twins after Ultrasound-Guided Umbilical Cord Occlusion
AU - Schou, Katrine Vasehus
AU - Ekelund, Charlotte Kvist
AU - Jensen, Lisa Neerup
AU - Nørgaard, Lone Nikoline
AU - Søgaard, Kirsten
AU - Rode, Line
AU - Tabor, Ann
AU - Sundberg, Karin
N1 - © 2019 S. Karger AG, Basel.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - OBJECTIVE: To determine hemodynamic changes by Doppler ultrasound of the living fetus during 24 h after umbilical cord occlusion (UCO) in monochorionic diamniotic (MCDA) twin pregnancies.METHOD: We conducted a prospective observational study on fetuses undergoing UCO from 2015 to 2017. Doppler parameters peak systolic velocity (PSV) and umbilical pulsatility index (PI) were obtained in the middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus (DV) before and right after UCO, and at 1, 3, 6, 12, and 24 h after. We used multiple of the median (MoM) to adjust for gestational age. Spaghetti plots visualized flow changes over time. Mixed model adjusting for paired longitudinal data compared the values at different time points.RESULTS: A total of 16 women were included. MCA-PSV dropped within the first hour after surgery from 0.91 to 0.82 MoM (p = 0.08). MCA-PI and UA-PI increased in the first hour from 0.75 to 0.91 MoM (p = 0.02) and 0.94 to 0.98 MoM (p = 0.22), respectively. The DV-PIV increased to 1.14 MoM 3 h after surgery (p = 0.07). The spaghetti plots illustrated the small changes within the first hours and showed a stabilization of flow measurements near initial values 24 h after UCO.CONCLUSION: Within the first hours after UCO the circulation of the survivor twin undergoes small hemodynamic changes.
AB - OBJECTIVE: To determine hemodynamic changes by Doppler ultrasound of the living fetus during 24 h after umbilical cord occlusion (UCO) in monochorionic diamniotic (MCDA) twin pregnancies.METHOD: We conducted a prospective observational study on fetuses undergoing UCO from 2015 to 2017. Doppler parameters peak systolic velocity (PSV) and umbilical pulsatility index (PI) were obtained in the middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus (DV) before and right after UCO, and at 1, 3, 6, 12, and 24 h after. We used multiple of the median (MoM) to adjust for gestational age. Spaghetti plots visualized flow changes over time. Mixed model adjusting for paired longitudinal data compared the values at different time points.RESULTS: A total of 16 women were included. MCA-PSV dropped within the first hour after surgery from 0.91 to 0.82 MoM (p = 0.08). MCA-PI and UA-PI increased in the first hour from 0.75 to 0.91 MoM (p = 0.02) and 0.94 to 0.98 MoM (p = 0.22), respectively. The DV-PIV increased to 1.14 MoM 3 h after surgery (p = 0.07). The spaghetti plots illustrated the small changes within the first hours and showed a stabilization of flow measurements near initial values 24 h after UCO.CONCLUSION: Within the first hours after UCO the circulation of the survivor twin undergoes small hemodynamic changes.
KW - Anemia
KW - Cerebroplacental ratio
KW - Doppler measurements
KW - Ductus venosus
KW - Middle cerebral artery
KW - Monochorionictwins
KW - Peak systolic velocity
KW - Selective feticide
KW - Umbilical artery
KW - Umbilical cord occlusion
UR - http://www.scopus.com/inward/record.url?scp=85067395737&partnerID=8YFLogxK
U2 - 10.1159/000500021
DO - 10.1159/000500021
M3 - Journal article
C2 - 31195393
VL - 47
SP - 45
EP - 53
JO - Fetal Diagnosis and Therapy
JF - Fetal Diagnosis and Therapy
SN - 1015-3837
IS - 1
ER -