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Short-Term Flow Changes in Monochorionic Survivor Twins after Ultrasound-Guided Umbilical Cord Occlusion

Authors
  • Schou, Katrine Vasehus
  • Ekelund, Charlotte Kvist
  • Jensen, Lisa Neerup
  • Nørgaard, Lone Nikoline
  • Søgaard, Kirsten
  • Rode, Line
  • Tabor, Ann
  • Sundberg, Karin
Type
Published Article
Journal
Fetal Diagnosis and Therapy
Publisher
S. Karger AG
Publication Date
Jun 13, 2019
Volume
47
Issue
1
Pages
45–53
Identifiers
DOI: 10.1159/000500021
PMID: 31195393
Source
Karger
Keywords
License
Green
External links

Abstract

Objective: To determine hemodynamic changes by Doppler ultrasound of the living fetus during 24 h after umbilical cord occlusion (UCO) in monochorionic diamniotic (MCDA) twin pregnancies. Method: We conducted a prospective observational study on fetuses undergoing UCO from 2015 to 2017. Doppler parameters peak systolic velocity (PSV) and umbilical pulsatility index (PI) were obtained in the middle cerebral artery (MCA), umbilical artery (UA) and ductus venosus (DV) before and right after UCO, and at 1, 3, 6, 12, and 24 h after. We used multiple of the median (MoM) to adjust for gestational age. Spaghetti plots visualized flow changes over time. Mixed model adjusting for paired longitudinal data compared the values at different time points. Results: A total of 16 women were included. MCA-PSV dropped within the first hour after surgery from 0.91 to 0.82 MoM (p = 0.08). MCA-PI and UA-PI increased in the first hour from 0.75 to 0.91 MoM (p = 0.02) and 0.94 to 0.98 MoM (p = 0.22), respectively. The DV-PIV increased to 1.14 MoM 3 h after surgery (p = 0.07). The spaghetti plots illustrated the small changes within the first hours and showed a stabilization of flow measurements near initial values 24 h after UCO. Conclusion: Within the first hours after UCO the circulation of the survivor twin undergoes small hemodynamic changes.

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