Maternal Utero-Placental Perfusion Discordance in Monochorionic-Diamniotic Twin Pregnancies with Selective Growth Restriction Assessed by Three-Dimensional Power Doppler Ultrasound
journal contributionposted on 11.05.2020, 14:12 by Lan Zhang, Xiyao Liu, Junnan Li, Xing Wang, Shuai Huang, Xiaofang Luo, Hua Zhang, Li Wen, Chao Tong, Richard Saffery, Jianying Yan, Hongbo Qi, Mark D Kilby, Philip N Baker
Background: The aim of this study was to assess the correlation between selective growth restriction (sGR) and co-twin utero-placental perfusion discordance by using three-dimensional power Doppler (3DPD). Material/Methods: We prospectively recruited 60 sGR and 64 normal monochorionic-diamniotic (MCDA) twin pregnancies. Vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were assessed by 3DPD, while umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) were assessed by conventional Doppler imaging. Results: In sGR co-twins, the VI, FI, VFI, MCA-PI, and CPR were significantly lower, while the UA-PI and MCA-PSV were significantly greater, in the smaller fetuses compared with the larger fetuses; significant differences were also observed in the VI, FI, VFI, CPR, and UA-PI in normal co-twins. Compared with the appropriately grown twins, the discordances of the VI, FI, VFI, UA-PI, MCA-PI, and CPR were increased in the sGR cohort. The discordances of the VI, FI, VFI, UA-PI, MCA-PI, and CPR were associated with birthweight discordance, and the FI discordance and CPR discordance were independently associated with sGR. The combination of the FI and CPR discordance showed a higher predictive accuracy for sGR, with an area under the ROC curve of 0.813, and a sensitivity and specificity of 68.33% and 85.94%, respectively. Conclusions: MCDA twin pregnancies with birthweight discordance presented utero-placental perfusion deterioration assessed by 3DPD prior to sGR diagnosis. Co-twin utero-placental perfusion discordance was significantly correlated with growth discordance, and this correlation was more predictive of sGR when 3DPD was combined with conventional Doppler imaging.
This study was funded by the Ministry of Science and Technology of China (2018YFC1002901 and 2016YFC1000407), the National Natural Science Foundation of China (81520108013, 81771613, 81671488, and 81871189), the Chongqing Municipal Education Commission (CXTDX201601014), and the Cultivated Foundation of the First Affiliated Hospital of Chongqing Medical University (PYJJ2017-17)
CitationMed Sci Monit 2020; 26:e919247
Published inMEDICAL SCIENCE MONITOR
PublisherINT SCIENTIFIC INFORMATION, INC
Science & TechnologyLife Sciences & BiomedicineMedicine, Research & ExperimentalResearch & Experimental MedicineGrowth DisordersPlacental CirculationPrenatal DiagnosisTwins, MonozygoticUltrasonography, Doppler, ColorFETAL-GROWTHPLACENTAL VASCULARIZATIONQUANTITATIVE ASSESSMENTVASCULATUREFLOWCIRCULATIONINDEXESVOLUME