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Outcome of monochorionic twin pregnancies with moderate amniotic fluid discordance adjoining twin–twin transfusion syndrome
Author(s) -
Hayashi Satoshi,
Anami Ai,
Ishii Keisuke,
Oba Mari S.,
Takahashi Yuichiro,
Nakata Masahiko,
Murotsuki Jun,
Murakoshi Takeshi,
Sago Haruhiko
Publication year - 2016
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.4765
Subject(s) - twin twin transfusion syndrome , medicine , amniotic fluid , umbilical artery , obstetrics , intrauterine growth restriction , twin pregnancy , monochorionic twins , survival rate , population , umbilical cord , pregnancy , gynecology , gestational age , fetus , biology , anatomy , genetics , environmental health
Abstract Objectives This study aimed to assess the perinatal outcome in monochorionic diamniotic (MD) twin pregnancies complicated by amniotic fluid discordance (AFD) adjoining twin–twin transfusion syndrome (TTTS). Methods An observational study of 84 consecutive MD twin pregnancies complicated by AFD that resembled TTTS was conducted. AFD adjoining TTTS was defined by a maximal vertical pocket of amniotic fluid ≤3 cm in one twin and ≥7 cm in the other excluding TTTS. The study population was divided into two groups, group 1 and group 2, according to positive and absent or reversed end‐diastolic flow (AREDF) in the umbilical artery, respectively. Results Fifteen of the 35 (42.9%) group 1 cases and 30 of the 49 (61.2%) group 2 cases progressed to TTTS. The overall survival and intact survival rate in constant AFD that never progressed to TTTS in group 1 was 100% (40/40) and 90% (36/40), respectively. The overall survival and intact survival rate of constant AFD in group 2 with selective intrauterine growth restriction (sIUGR) was 54.2% (13/24) and 41.7% (10/24), respectively, and for those without sIUGR was 64.3% (9/14) and 57.1% (8/14), respectively. Conclusions Constant AFD with AREDF in the umbilical artery represents an extremely high risk for adverse outcomes regardless of the presence of sIUGR. © 2015 John Wiley & Sons, Ltd.