Doppler assessment of fetal aortic isthmus flow in twin
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective The purpose of this study was to investigate the aortic isthmus (AoI) flow difference between larger fetus and smallerfetus of twin; and to evaluate the predictive value of early diagnosis of hemodynamic change in twin growth. Methods This prospective study on 49 pairs of twin fetuses was performed to obtain AoI blood flow data. Cases with structuralor chromosomal abnormalities and co-twin death were excluded. The interval from examination to delivery was within4 weeks and 3 cases over 4 weeks interval were re-examined. Assessment of fetal AoI Doppler parameters were peaksystolic velocity (PSV), end-diastolic velocity, times-averaged maximum velocities, pulsatility index (PI), and resistanceindex (RI). According to the direction of the diastolic flow in the AoI, antegrade and retrograde flow were made and wasused to analyze the perinatal outcomes of each fetus. The predictive value of AoI Doppler parameters in predicting fetalgrowth was obtained by using ANOVA and logistic regression analysis of quantitative variables in each fetus of twins. Results There were significant differences in the gestational weeks at delivery, birth weight and the incidence of growthdiscordance over 20% or more between monochorionic twin and dichorionic twin. The AoI PI and RI were significantlyhigher in smaller fetus than in larger regardless of chorionicity. Retrograde flow was noted in 8 of 98 cases (8.2%) andthe only one case was of the larger fetus and the others were smaller fetuses of twin. Significant correlations werefound between the AoI PI and birthweight (P=0.018) and between the PSV and growth discordance (P=0.032). Inmonochorionic twin, linear correlation was shown between the AoI PI and birthweight (P=0.004) and between AoI PIand growth discordance (P=0.031). Also, the meaningful correlation between the PSV and birthweight (P=0.036) wasfound by using logistic regression analyses. ConclusionOn the basis of our observation, AoI PI has revealed their hemodynamic status and this result may improve theunderstanding of growth patterns in twins.
Abstract
Objective The purpose of this study was to investigate the aortic isthmus (AoI) flow difference between larger fetus and smallerfetus of twin; and to evaluate the predictive value of early diagnosis of hemodynamic change in twin growth. Methods This prospective study on 49 pairs of twin fetuses was performed to obtain AoI blood flow data. Cases with structuralor chromosomal abnormalities and co-twin death were excluded. The interval from examination to delivery was within4 weeks and 3 cases over 4 weeks interval were re-examined. Assessment of fetal AoI Doppler parameters were peaksystolic velocity (PSV), end-diastolic velocity, times-averaged maximum velocities, pulsatility index (PI), and resistanceindex (RI). According to the direction of the diastolic flow in the AoI, antegrade and retrograde flow were made and wasused to analyze the perinatal outcomes of each fetus. The predictive value of AoI Doppler parameters in predicting fetalgrowth was obtained by using ANOVA and logistic regression analysis of quantitative variables in each fetus of twins. Results There were significant differences in the gestational weeks at delivery, birth weight and the incidence of growthdiscordance over 20% or more between monochorionic twin and dichorionic twin. The AoI PI and RI were significantlyhigher in smaller fetus than in larger regardless of chorionicity. Retrograde flow was noted in 8 of 98 cases (8.2%) andthe only one case was of the larger fetus and the others were smaller fetuses of twin. Significant correlations werefound between the AoI PI and birthweight (P=0.018) and between the PSV and growth discordance (P=0.032). Inmonochorionic twin, linear correlation was shown between the AoI PI and birthweight (P=0.004) and between AoI PIand growth discordance (P=0.031). Also, the meaningful correlation between the PSV and birthweight (P=0.036) wasfound by using logistic regression analyses. ConclusionOn the basis of our observation, AoI PI has revealed their hemodynamic status and this result may improve theunderstanding of growth patterns in twins.
참고문헌 (23)
- Fouron JC., "The unrecognized physiological and clinical significance of the fetal aortic isthmus", Ultrasound Obstet Gynecol, 22, pp.441~447 (2003)
- Baschat AA., "Fetal responses to placental insufficiency : an update", BJOG, 111, pp.1031~1041 (2004)
- Bilardo CM., "Relationship between monitoring parameters and perinatal outcome in severe, early intrauterine growth restriction", Ultrasound Obstet Gynecol, 23, pp.119~125 (2004)
- Eronen M., "Value of absent or retrograde end-diastolic flow in fetal aorta and umbilical artery as a predictor of perinatal outcome in pregnancy-induced hypertension", Acta Paediatr, 82, pp.919~924 (1993)
- Eberle AM., "Placental pathology in discordant twins", Am J Obstet Gynecol, 169, pp.931~935 (1993)
- Weissman A., "The first-trimester growth-discordant twin : an ominous prenatal finding", Obstet Gynecol, 84, pp.110~114 (1994)
- Benirschke K., "Intrauterine death of a twin : mechanisms, implications for surviving twin, and placental pathology", Semin Diagn Pathol, 10, pp.222~231 (1993)
- Fouron JC., "Relationship between flow through the fetal aortic isthmus and cerebral oxygenation during acute placental circulatory insufficiency in ovine fetuses", Am J Obstet Gynecol, 181(5 Pt 1), pp.1102~1107 (1999)
- Makikallio K., "Retrograde aortic isthmus net blood flow and human fetal cardiac function in placental insufficiency", Ultrasound Obstet Gynecol, 22, pp.351~357 (2003)
- Baschat AA., "The sequence of changes in Doppler and biophysical parameters as severe fetal growth restriction worsens", Ultrasound Obstet Gynecol, 18, pp.571~577 (2001)
- Cosmi E., "Doppler, cardiotocography, and biophysical profile changes in growth-restricted fetuses", Obstet Gynecol, 106, pp.1240~1245 (2005)
- Ferrazzi E., "Temporal sequence of abnormal Doppler changes in the peripheral and central circulatory systems of the severely growth-restricted fetus", Ultrasound Obstet Gynecol, 19, pp.140~146 (2002)
- Hecher K., "Monitoring of fetuses with intrauterine growth restriction : a longitudinal study", Ultrasound Obstet Gynecol, 18, pp.564~570 (2001)
- Figueras F., "Monitoring of fetuses with intrauterine growth restriction : longitudinal changes in ductus venosus and aortic isthmus flow", Ultrasound Obstet Gynecol, 33, pp.39~43 (2009)
- Allen LD, "Textbook of fetal cardiology", pp.81~89 (2000), Greenwich Medical Media Limited
- Del Rio M., "Reference ranges for Doppler parameters of the fetal aortic isthmus during the second half of pregnancy", Ultrasound Obstet Gynecol, 28, pp.71~76 (2006)
- Ruskamp J., "Reference values for an index of fetal aortic isthmus blood flow during the second half of pregnancy", Ultrasound Obstet Gynecol, 21, pp.441~444 (2003)
- Del Rio M., "Doppler assessment of fetal aortic isthmus blood flow in two different sonographic planes during the second half of gestation", Ultrasound Obstet Gynecol, 26, pp.170~174 (2005)
- Gosling RG, "Arteries and vein", pp.61~98 (1975), Churchill Livingstone
- Bonnin P., "Quantitative assessment of circulatory changes in the fetal aortic isthmus during progressive increase of resistance to umbilical blood flow", Circulation, 88, pp.216~222 (1993)
- Sonesson SE., "Doppler velocimetry of the aortic isthmus in human fetuses with abnormal velocity waveforms in the umbilical artery", Ultrasound Obstet Gynecol, 10, pp.107~111 (1997)
- Rizzo G., "Ventricular ejection force in growth-retarded fetuses", Ultrasound Obstet Gynecol, 5, pp.247~255 (1995)
- Del Rio M., "Doppler assessment of the aortic isthmus and perinatal outcome in preterm fetuses with severe intrauterine growth restriction", Ultrasound Obstet Gynecol, 31, pp.41~47 (2008)