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Management of small‐for‐gestational‐age twins with absent/reversed end diastolic flow in the umbilical artery: outcome of a policy of daily biophysical profile (BPP)
Author(s) -
Kennelly Máiréad M.,
Sturgiss Stephen N.
Publication year - 2007
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.1630
Subject(s) - umbilical artery , gestational age , medicine , fetus , obstetrics , pregnancy , twin pregnancy , monochorionic twins , gestation , small for gestational age , diastole , blood pressure , genetics , biology
Abstract Objectives To evaluate a strategy of daily biophysical profile (BPP) for pregnancies with small‐for‐gestational‐age twins and with absent or reversed end diastolic flow (AREDF) in the umbilical artery of one twin and to assess the latency interval between detection and delivery in monochorionic (MC) and dichorionic (DC) twin pregnancy. Methods A search of the Fetal Medicine Database was carried out between 2000 and 2005 at a single tertiary centre to identify all cases with AREDF in the umbilical artery with one small‐for‐gestational‐age twin. Active monitoring with daily BPP was undertaken, once the estimated fetal weights (EFW) was ≥ 500 g and at a gestational age of ≥ 24 weeks in both twins. Delivery was timed on the basis of an abnormal BPP, two equivocal BPP within 12 h or gestational age of ≥ 32 +0 weeks. Results Twenty‐two MC and 17 DC twin pregnancies were identified. There were no fetal losses in the viable actively monitored MC (19) and DC (13) twins. There was a longer latency interval in the MC group at 21.7 days versus 14.4 days in the DC group (p = 0.13). Delivery was indicated for an abnormal BPP (57.8% MC vs 30.8% DC). Conclusions A strategy of daily BPP can be used to monitor preterm twin fetuses with AREDF, prolonging pregnancy with an acceptable perinatal outcome. Copyright © 2007 John Wiley & Sons, Ltd.