Premium
Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and Doppler ultrasound
Author(s) -
Delabaere Amélie,
Leduc France,
Reboul Quentin,
Fuchs Florent,
Wavrant Sandrine,
Dubé Johanne,
Fouron JeanClaude,
Audibert François
Publication year - 2018
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.5280
Subject(s) - ductus venosus , medicine , cardiology , middle cerebral artery , umbilical artery , fetus , twin to twin transfusion syndrome , monochorionic twins , pregnancy , ischemia , genetics , biology
Objective To determine the prognostic value of fetal Doppler and echocardiographic parameters for intrauterine fetal demise (IUFD) within 24 hours and within 1 week after laser coagulation in monochorionic pregnancies complicated by twin‐twin transfusion syndrome. Method This retrospective study correlated the preoperative hemodynamic and echocardiography parameters to the outcome in fetuses with twin‐twin transfusion syndrome undergoing laser therapy. Results One hundred and twelve laser coagulations were performed between February 2006 and June 2015. The total (single and double) IUFD rate was 27.7%. Further, 59% of IUFD occurred within 24 hours and 74.4% occurred within 1 week after laser. The following were associated to IUFD within 24 hours: the middle cerebral arterial pulsatility index in the donor, abnormal umbilical artery (UA) end diastolic flow, increased middle cerebral artery peak systolic velocity, and right ventricular myocardial performance index (RV‐MPI) z ‐score in the recipient. For IUFD within 1 week were the pulsatility index in the donor UA and the recipient abnormalities in UA, ductus venosus, middle cerebral artery‐peak systolic velocity, and RV‐MPI z ‐score. Conclusion Following laser was early IUFD that was associated with Doppler findings suggesting donor cerebroplacental redistribution, and recipient overload cardiomyopathy, such as abnormal ductus venosus and UA Dopplers as well as an increase of RV‐MPI.