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Fetal umbilical artery flow velocity‐time waveforms in twin pregnancies
Author(s) -
GILES WARWICK B.,
TRUDINGER BRIAN J.,
COOK COLLEEN M.
Publication year - 1985
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1985.tb01354.x
Subject(s) - umbilical artery , obstetrics , medicine , twin pregnancy , fetus , gestational age , monochorionic twins , small for gestational age , anastomosis , birth weight , pregnancy , surgery , biology , genetics
Summary. The umbilical artery flow velocity‐time waveforms were studied in 76 twin pregnancies. The ratio of peak systolic (A) to least diastolic (El) velocity was calculated for each fetus as an index of umbilical placental flow resistance. Seventy‐one sets of twins were studied within 14 days before delivery. In 65 cases both twins were alive at the time of study. In 32 pregnancies both fetuses were of birthweight appropriate for gestational age (AGA) and had A/B ratios within the normal singleton range. In 33 pregnancies one or both of the liveborn infants were small for gestational age (SGA) and in 78% of these at least one fetus had an elevated A/B ratio. Discordancy in birthweight and A/B ratio was associated with growth retardation. Clinically manifest twin‐to‐twin transfusions occurred in five of the ten pregnancies resulting in an SGA infant (eight with discordant weight) associated with a normal and concordant A/B ratio. Two twin‐to‐twin transfusions were associated with perinatal death. The placentas were examined in 61 patients. In 43 dichorionic pairs the A/B ratio was elevated in 12 of the 18 where there was at least one SGA infant. There was a greater incidence of growth retardation in the monochorionic pairs (12 of 18). Only seven of these were identified by an elevated A/B ratio. In 10 of these 18 pairs vascular anastomoses were demonstrated on placental inspection and in a further two there was evidence of twin‐to‐twin transfusion by haemoglobin discrepancy. Twin pregnancy may result in the birth of a small‐for‐dates infant because of intrauterine growth retardation or twin‐to‐twin transfusion. An abnormally elevated A/B ratio identifies growth retardation. In twin‐to‐twin transfusion the A/B ratio of the two fetuses is similar (crossed circulation) yet difference in size may be seen on ultrasound measurement.