Objectives To evaluate the role of uterine artery Doppler in the expectant management of dichorionic twin pregnancies discordant for intrauterine growth restriction (IUGR). Methods Retrospective study. We retrieved from our database (2002–2012) data on dichorionic twin pregnancies complicated by IUGR of one twin, defined as abdominal circumference <5th percentile and umbilical artery pulsatility index >95th percentile, with no structural or chromosomal abnormalities. Perinatal and pediatric records were examined. In all cases gestational age and chorionicity were determined by ultrasound in the first trimester. Chorionicity was confirmed by placental pathology. Results We identified 31 dichorionic twin pregnancies discordant for IUGR. The median gestation at presentation was 26+3 weeks (interquartile range (IQR) 24+0-30+4 weeks). Pre-eclampsia (PE) complicated 8/31 cases. Uterine artery Doppler was evaluated in 28/31 cases, and mean PI was > 95th percentile in 10/28, of which half (5/10) subsequently developed PE, requiring delivery before 32 weeks in 3/5 of cases All pregnancies were offered expectant managed for fetal conditions until 32 weeks. In 5/31 (16%) cases delivery was carried out before 32 weeks because of severe PE (n = 4) or placental abruption (n = 1). There were 7 perinatal deaths. The IUGR twin died in 6/31 pregnancies (19%); in 5 cases intrauterine death occurred before 32 weeks. In one pregnancy both twins died in the neonatal period after a Caesarean section performed at 27+0 weeks because of severe PE. Among the 55 survivors there were 4 infants with disability. The relative risk of developing pre-eclampsia with abnormal uterine artery Doppler waveform in our cohort was 4.5 (1.05-19.11, 95% confidence interval; p = 0.04). Conclusions Uterine artery Doppler might be useful to identify cases at higher risk of pre-eclampsia that warrant increased maternal surveillance during expectant management.
Uterine artery Doppler in the management of dichorionic twin pregnancies discordant for intrauterine growth restriction
FRANCESCHETTI, Laura;FICHERA, Anna;MARELLA, DARIA;LOARDI, Chiara;VALCAMONICO, ADRIANA;PREFUMO, FEDERICO
2016-01-01
Abstract
Objectives To evaluate the role of uterine artery Doppler in the expectant management of dichorionic twin pregnancies discordant for intrauterine growth restriction (IUGR). Methods Retrospective study. We retrieved from our database (2002–2012) data on dichorionic twin pregnancies complicated by IUGR of one twin, defined as abdominal circumference <5th percentile and umbilical artery pulsatility index >95th percentile, with no structural or chromosomal abnormalities. Perinatal and pediatric records were examined. In all cases gestational age and chorionicity were determined by ultrasound in the first trimester. Chorionicity was confirmed by placental pathology. Results We identified 31 dichorionic twin pregnancies discordant for IUGR. The median gestation at presentation was 26+3 weeks (interquartile range (IQR) 24+0-30+4 weeks). Pre-eclampsia (PE) complicated 8/31 cases. Uterine artery Doppler was evaluated in 28/31 cases, and mean PI was > 95th percentile in 10/28, of which half (5/10) subsequently developed PE, requiring delivery before 32 weeks in 3/5 of cases All pregnancies were offered expectant managed for fetal conditions until 32 weeks. In 5/31 (16%) cases delivery was carried out before 32 weeks because of severe PE (n = 4) or placental abruption (n = 1). There were 7 perinatal deaths. The IUGR twin died in 6/31 pregnancies (19%); in 5 cases intrauterine death occurred before 32 weeks. In one pregnancy both twins died in the neonatal period after a Caesarean section performed at 27+0 weeks because of severe PE. Among the 55 survivors there were 4 infants with disability. The relative risk of developing pre-eclampsia with abnormal uterine artery Doppler waveform in our cohort was 4.5 (1.05-19.11, 95% confidence interval; p = 0.04). Conclusions Uterine artery Doppler might be useful to identify cases at higher risk of pre-eclampsia that warrant increased maternal surveillance during expectant management.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
