Umbilical venous volume flow in twin-twin transfusion syndrome

S. Gungor, P. Glosemeyer, A. Huber, K. Hecher, Ahmet Baschat

Research output: Contribution to journalArticle

Abstract

Objectives To examine umbilical venous volume flow (UVF) dynamics by twin status and disease severity in untreated twin-twin transfusion syndrome (TTTS). Methods In 70 cases of untreated TTTS, absolute UVF, UVF corrected for estimated fetal weight (UVF/kg), intertwin difference (Δ UVF/kg) and recipient to donor ratio (R/D-UVF/kg) were calculated. Parameters for UVF were compared with respect to twin status and disease severity (early, Quintero Stages I and II; advanced, Stages III and IV). Results UVF/kg was higher in recipients than in donors and decreased with advancing stage in both twins (in recipients, 183.9 mL/kg/min vs. 145.6 mL/kg/min, P = 0.043; in donors, 137.5 mL/kg/min vs. 122.5 mL/kg/min, P = 0.033). Linear regression analysis demonstrated that the overall best correlation coefficient for ΔUVF/kg was obtained for the Doppler pulsatility index of the umbilical artery (t = -4.536, P <0.001). In advanced stage, absolute and weight-corrected UVF were lower overall, while significant differences in intertwin volume flows persisted. The lowest flows were observed in hydropic recipients (median, 67.0 (range, 55.2-122.0) mL/kg/min vs. 180.8 (range, 59.1-565.4) mL/kg/min; P = 0.001). Conclusions In TTTS, UVF is significantly higher in recipients than in donors. With progression to advanced stage UVF/kg decreases in both twins as the magnitude of UVF that can be accommodated by the recipient declines. Further study of these dynamics in combination with cardiac performance parameters is warranted to refine diagnostic and prognostic assessment.

Original languageEnglish (US)
Pages (from-to)800-806
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume32
Issue number6
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Fetofetal Transfusion
Umbilicus
Fetal Weight
Umbilical Arteries

Keywords

  • Doppler
  • Ductus venosus
  • Twin-twin transfusion
  • Umbilical venous volume flow

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

Cite this

Umbilical venous volume flow in twin-twin transfusion syndrome. / Gungor, S.; Glosemeyer, P.; Huber, A.; Hecher, K.; Baschat, Ahmet.

In: Ultrasound in Obstetrics and Gynecology, Vol. 32, No. 6, 11.2008, p. 800-806.

Research output: Contribution to journalArticle

Gungor, S. ; Glosemeyer, P. ; Huber, A. ; Hecher, K. ; Baschat, Ahmet. / Umbilical venous volume flow in twin-twin transfusion syndrome. In: Ultrasound in Obstetrics and Gynecology. 2008 ; Vol. 32, No. 6. pp. 800-806.
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abstract = "Objectives To examine umbilical venous volume flow (UVF) dynamics by twin status and disease severity in untreated twin-twin transfusion syndrome (TTTS). Methods In 70 cases of untreated TTTS, absolute UVF, UVF corrected for estimated fetal weight (UVF/kg), intertwin difference (Δ UVF/kg) and recipient to donor ratio (R/D-UVF/kg) were calculated. Parameters for UVF were compared with respect to twin status and disease severity (early, Quintero Stages I and II; advanced, Stages III and IV). Results UVF/kg was higher in recipients than in donors and decreased with advancing stage in both twins (in recipients, 183.9 mL/kg/min vs. 145.6 mL/kg/min, P = 0.043; in donors, 137.5 mL/kg/min vs. 122.5 mL/kg/min, P = 0.033). Linear regression analysis demonstrated that the overall best correlation coefficient for ΔUVF/kg was obtained for the Doppler pulsatility index of the umbilical artery (t = -4.536, P <0.001). In advanced stage, absolute and weight-corrected UVF were lower overall, while significant differences in intertwin volume flows persisted. The lowest flows were observed in hydropic recipients (median, 67.0 (range, 55.2-122.0) mL/kg/min vs. 180.8 (range, 59.1-565.4) mL/kg/min; P = 0.001). Conclusions In TTTS, UVF is significantly higher in recipients than in donors. With progression to advanced stage UVF/kg decreases in both twins as the magnitude of UVF that can be accommodated by the recipient declines. Further study of these dynamics in combination with cardiac performance parameters is warranted to refine diagnostic and prognostic assessment.",
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N2 - Objectives To examine umbilical venous volume flow (UVF) dynamics by twin status and disease severity in untreated twin-twin transfusion syndrome (TTTS). Methods In 70 cases of untreated TTTS, absolute UVF, UVF corrected for estimated fetal weight (UVF/kg), intertwin difference (Δ UVF/kg) and recipient to donor ratio (R/D-UVF/kg) were calculated. Parameters for UVF were compared with respect to twin status and disease severity (early, Quintero Stages I and II; advanced, Stages III and IV). Results UVF/kg was higher in recipients than in donors and decreased with advancing stage in both twins (in recipients, 183.9 mL/kg/min vs. 145.6 mL/kg/min, P = 0.043; in donors, 137.5 mL/kg/min vs. 122.5 mL/kg/min, P = 0.033). Linear regression analysis demonstrated that the overall best correlation coefficient for ΔUVF/kg was obtained for the Doppler pulsatility index of the umbilical artery (t = -4.536, P <0.001). In advanced stage, absolute and weight-corrected UVF were lower overall, while significant differences in intertwin volume flows persisted. The lowest flows were observed in hydropic recipients (median, 67.0 (range, 55.2-122.0) mL/kg/min vs. 180.8 (range, 59.1-565.4) mL/kg/min; P = 0.001). Conclusions In TTTS, UVF is significantly higher in recipients than in donors. With progression to advanced stage UVF/kg decreases in both twins as the magnitude of UVF that can be accommodated by the recipient declines. Further study of these dynamics in combination with cardiac performance parameters is warranted to refine diagnostic and prognostic assessment.

AB - Objectives To examine umbilical venous volume flow (UVF) dynamics by twin status and disease severity in untreated twin-twin transfusion syndrome (TTTS). Methods In 70 cases of untreated TTTS, absolute UVF, UVF corrected for estimated fetal weight (UVF/kg), intertwin difference (Δ UVF/kg) and recipient to donor ratio (R/D-UVF/kg) were calculated. Parameters for UVF were compared with respect to twin status and disease severity (early, Quintero Stages I and II; advanced, Stages III and IV). Results UVF/kg was higher in recipients than in donors and decreased with advancing stage in both twins (in recipients, 183.9 mL/kg/min vs. 145.6 mL/kg/min, P = 0.043; in donors, 137.5 mL/kg/min vs. 122.5 mL/kg/min, P = 0.033). Linear regression analysis demonstrated that the overall best correlation coefficient for ΔUVF/kg was obtained for the Doppler pulsatility index of the umbilical artery (t = -4.536, P <0.001). In advanced stage, absolute and weight-corrected UVF were lower overall, while significant differences in intertwin volume flows persisted. The lowest flows were observed in hydropic recipients (median, 67.0 (range, 55.2-122.0) mL/kg/min vs. 180.8 (range, 59.1-565.4) mL/kg/min; P = 0.001). Conclusions In TTTS, UVF is significantly higher in recipients than in donors. With progression to advanced stage UVF/kg decreases in both twins as the magnitude of UVF that can be accommodated by the recipient declines. Further study of these dynamics in combination with cardiac performance parameters is warranted to refine diagnostic and prognostic assessment.

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KW - Ductus venosus

KW - Twin-twin transfusion

KW - Umbilical venous volume flow

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