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Doppler velocimetry for predicting fetal death in a twin pregnancy.

Soikkeli, Pia; Dubiel, Mariusz and Gudmundsson, Saemundur LU (2002) In Acta Obstetricia et Gynecologica Scandinavica 81(8). p.783-785
Abstract
Diagnosis of discordant twins is easily accomplished with modern ultrasound equipment, though diagnosing twin-to-twin transfusion syndrome (TTS) at an early stage might be a problem. The possibility of excluding TTS by Doppler ultrasound is demonstrated in a case with early severe growth restriction of one fetus. Characteristic blood velocity changes in a dying fetus are also illustrated.



The Doppler technique has become an accepted method in obstetrics for antenatal surveillance, permitting evaluation of fetal circulation in a non-invasive manner and providing important physiological information on the fetal condition. Absent end-diastolic flow in the umbilical artery (UA) can warrant operative delivery for fetal... (More)
Diagnosis of discordant twins is easily accomplished with modern ultrasound equipment, though diagnosing twin-to-twin transfusion syndrome (TTS) at an early stage might be a problem. The possibility of excluding TTS by Doppler ultrasound is demonstrated in a case with early severe growth restriction of one fetus. Characteristic blood velocity changes in a dying fetus are also illustrated.



The Doppler technique has become an accepted method in obstetrics for antenatal surveillance, permitting evaluation of fetal circulation in a non-invasive manner and providing important physiological information on the fetal condition. Absent end-diastolic flow in the umbilical artery (UA) can warrant operative delivery for fetal distress (1).



Perinatal mortality is increased fivefold in multiple gestation, as compared with singleton pregnancy (2). The major complications include preterm labor, intrauterine growth retardation (IUGR), TTS, polyhydramnios, oligohydramnios, fetal malformations, and pre-eclampsia. Twin fetuses are generally smaller than singletons and IUGR and intrauterine fetal deaths are more common (3).



Before the introduction of the Doppler technique, ultrasound-imaging evaluation of discordant fetal size in twin pregnancy was a problem. Differential diagnosis of TTS and a true growth retardation of one fetus was a frequent worry for the clinician. Doppler examination of the fetal venous circulation with pulsating flow in the umbilical vein has been found helpful in the diagnosis of fetal congestive heart failure (4, 5). The general ultrasound imaging and Doppler findings in TTS are listed in Fig. 1. The information provided by ultrasound imaging and Doppler can thus distinguish between TTS and growth retardation of one fetus and assist the clinician in making a diagnosis and predict the outcome. The following case illustrates characteristic blood velocity findings in a dying fetus. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Female, Differential, Diagnosis, Twins, Pulsatile Flow, Second, Ultrasonography, Prenatal, Umbilical Arteries: physiology, Case Report, Adult, Fetal Death: ultrasonography, Fetus: blood supply, Human, Parity, Pregnancy, Pregnancy Trimester
in
Acta Obstetricia et Gynecologica Scandinavica
volume
81
issue
8
pages
783 - 785
publisher
Wiley-Blackwell
external identifiers
  • pmid:12174166
  • wos:000177381700017
  • scopus:0036686771
ISSN
1600-0412
DOI
10.1034/j.1600-0412.2002.810817.x
language
English
LU publication?
yes
id
319deaff-928b-447d-afce-a39fce9c8859 (old id 115010)
date added to LUP
2007-08-17 10:38:18
date last changed
2017-01-01 07:22:39
@article{319deaff-928b-447d-afce-a39fce9c8859,
  abstract     = {Diagnosis of discordant twins is easily accomplished with modern ultrasound equipment, though diagnosing twin-to-twin transfusion syndrome (TTS) at an early stage might be a problem. The possibility of excluding TTS by Doppler ultrasound is demonstrated in a case with early severe growth restriction of one fetus. Characteristic blood velocity changes in a dying fetus are also illustrated.<br/><br>
<br/><br>
The Doppler technique has become an accepted method in obstetrics for antenatal surveillance, permitting evaluation of fetal circulation in a non-invasive manner and providing important physiological information on the fetal condition. Absent end-diastolic flow in the umbilical artery (UA) can warrant operative delivery for fetal distress (1).<br/><br>
<br/><br>
Perinatal mortality is increased fivefold in multiple gestation, as compared with singleton pregnancy (2). The major complications include preterm labor, intrauterine growth retardation (IUGR), TTS, polyhydramnios, oligohydramnios, fetal malformations, and pre-eclampsia. Twin fetuses are generally smaller than singletons and IUGR and intrauterine fetal deaths are more common (3).<br/><br>
<br/><br>
Before the introduction of the Doppler technique, ultrasound-imaging evaluation of discordant fetal size in twin pregnancy was a problem. Differential diagnosis of TTS and a true growth retardation of one fetus was a frequent worry for the clinician. Doppler examination of the fetal venous circulation with pulsating flow in the umbilical vein has been found helpful in the diagnosis of fetal congestive heart failure (4, 5). The general ultrasound imaging and Doppler findings in TTS are listed in Fig. 1. The information provided by ultrasound imaging and Doppler can thus distinguish between TTS and growth retardation of one fetus and assist the clinician in making a diagnosis and predict the outcome. The following case illustrates characteristic blood velocity findings in a dying fetus.},
  author       = {Soikkeli, Pia and Dubiel, Mariusz and Gudmundsson, Saemundur},
  issn         = {1600-0412},
  keyword      = {Female,Differential,Diagnosis,Twins,Pulsatile Flow,Second,Ultrasonography,Prenatal,Umbilical Arteries: physiology,Case Report,Adult,Fetal Death: ultrasonography,Fetus: blood supply,Human,Parity,Pregnancy,Pregnancy Trimester},
  language     = {eng},
  number       = {8},
  pages        = {783--785},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Doppler velocimetry for predicting fetal death in a twin pregnancy.},
  url          = {http://dx.doi.org/10.1034/j.1600-0412.2002.810817.x},
  volume       = {81},
  year         = {2002},
}