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WS13‐03Dynamics and clinical significance of placental shunt flow in monochorionic diamniotic twins
Author(s) -
Maeda K.,
Utsu M.,
Hirai T.,
Sakata M.,
Yamamoto N.,
Ohki S.
Publication year - 2000
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2000.00009-1-79.x
Subject(s) - medicine , shunt (medical) , umbilical artery , placenta , umbilical vein , obstetrics , blood flow , pregnancy , fetus , cardiology , biochemistry , chemistry , biology , in vitro , genetics
Background The aim is to clarify placental shunt flow patterns in monochorionic diamniotic (MD) twins and their clinical outcome after the intervention under unique criteria. Method Thirteen (13) MD twin pregnancies were studied from early pregnancy with 2D and 3D B‐mode, color Doppler, power‐angio mode, Doppler flow velocimetry, cardio‐thoraxarea ratio (CTAR) and preload index (PLI) under tocolysis. Results Artery to artery shunt flow was detected by fetalbeat‐to‐beat Doppler color change and cyclic bidirectionalflow at placental surface in 8 MD twin cases but not in 5. Shunt was more clear with 3D color Doppler and power‐angio. Umbilical vein flow pulsation, variable FHR deceleration andcord complications were more in placental shunt flow casesthan its absence. Deep shunt flow was prenatally detected in 2 cases and small anastomses in all postnatal placenta. Pregnancy was terminated by emergency C‐section in cases of uncontrollable contractions, unidirectional shunt flow, large CTAR and PLI (> 0.4) which were frequent in large twins after 30 weeks. Neonatal cardiac failure was more in shunt flow cases than its absence but the outcome was normal. Neonatal PVL and perinatal deaths were less than the MD twins in the past.