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Ultrasound Obstet Gynecol. 2015 May;45(5):544-50. doi: 10.1002/uog.13449. Epub 2015 Apr 7.

Time-interval analysis of ductus venosus flow velocity waveforms in twin-to-twin transfusion syndrome treated with laser surgery.

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1
Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.

Abstract

OBJECTIVES:

To investigate time-interval variables of ductus venosus (DV) flow velocity waveforms (FVWs) in twin-to-twin transfusion syndrome (TTTS), comparing the results with reference ranges from normal singleton fetuses. The impact of laser surgery and the effect of prognostic factors were also evaluated.

METHODS:

In 107 TTTS cases, DV-FVWs of both recipients and donors were recorded 1 day before and 2 days after laser therapy. Time intervals for systolic (S) and early diastolic (D) peaks were analyzed retrospectively with regard to acceleration time (acc-S and acc-D for S and D, respectively) and deceleration time (dec-S and dec-D for S and D, respectively). For each variable, Z-scores were calculated with respect to previously reported normal reference ranges.

RESULTS:

Z-scores for all variables showed statistically significant differences from those observed previously in normal fetuses, with the exception of dec-S of donors. The most striking differences were observed in longer dec-S of recipients (P < 0.001) and longer dec-D of donors (P < 0.001). Laser therapy showed significant impact on dec-S and acc-D in recipients and on all variables in donors. Regarding the short-term prognosis, acc-S and dec-S showed significant differences for the prediction of intrauterine fetal demise in donors (P = 0.009 and P = 0.011, respectively).

CONCLUSION:

This study demonstrates that time-interval variables of DV-FVWs may differentiate the characteristic hemodynamic changes caused by unbalanced blood volume between recipients and donors.

KEYWORDS:

ductus venosus; laser surgery; monochorionic twins; time-related analysis; twin-to-twin transfusion syndrome

PMID:
24975921
DOI:
10.1002/uog.13449
[Indexed for MEDLINE]
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