Sep 3, 2006 - 1Silesian Medical School, Poland, 2Polish Mother's Memorial. Hospital, Poland, 3University of South Florida, United States ... ultrasound.
3–7 September 2006, London, UK
our centre, at between 26 to 33 weeks of gestation in order to screen for subtle fetal cerebral lesions. Gestational age was established according to crown-rump length. Fetal cerebral maturation was characterized according to gyration for gestational age in both twins. One donor presented a delay in fetal cerebral maturation at 28 weeks of gestation. This fetus had growth retardation < 3th percentile. Delayed gyration consisted of a 2 week-delay as compared to that of its co-twin. Neurological development was normal in both twins at 3, 6 and 12 months of age. In conclusion, delay in fetal brain maturation may occur in TTTS even in cases with two survivors and a normal outcome. This should be accounted for in the follow-up of these cases.
P05.25 A cardiovascular profile score assessment of cardiac dysfunction in the recipient and donor twins in severe twin–twin transfusion syndrome A. Wloch1 , B. Czuba1 , D. Borowski2 , W. Cnota1 , P. Kaczmarek2 , K. Sodowski1 , K. Szaflik2 , J. C. Huhta3 Silesian Medical School, Poland, 2 Polish Mother’s Memorial Hospital, Poland, 3 University of South Florida, United States
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Objective: To assess the value of cardiovascular profile score (CVPS) focusing on the cardiac function in the surveillance of both twins in twin-to-twin transfusion syndrome. Methods: In a retrospective study 16 recipient and 16 donor twins were examined between 18–26 (mean 21) weeks of gestation at the first echo exam with ultrasonographic evaluation of presence of hydrops, heart size, cardiac function, venous and arterial Doppler. The scores of the first and final examinations after treatment were compared in both twins and the relationship between these scores and the progress of developing the congestive heart failure (CHF) and fetal outcome was assessed. Results: The median CVPS for recipients at the first assessment was 7.0 and 9.0 for donors. For these included to the longitudinal arm of the study (13 recipients, 13 donors) the CVPS was 7.0 for recipients who survived and 6.0 for those who died and 8.0 for donors who died and the same who survived. Cardiac function in recipients was impaired in 100% cases (minus 1 point in 10 cases, minus 2 points in 6 cases). Tricuspid valve regurgitation (16/100%), mild cardiomegaly (12/75%) and myocardial hypertrophy (9/56%) were the most frequent findings in the recipients. Functional pulmonary atresia in two cases and supravalvar pulmonary stenosis in one was recognized. Cardiac function was abnormal in one donor twin due to CHF after laser therapy. Most had abnormal arterial (8/50%) or arterial and venous (6/38%) Doppler flows. In utero treatment included: serial amnioreduction in 10 cases, laser therapy in 5 and digoxin therapy in 3 cases. Overall survival rate was 53% (15/32) (donors 53%, recipients 47%). Conclusions: 1. The CVPS can be used in the surveillance of recipients for prediction of the presence of congestive heart failure and fetal outcome. 2. Cardiac function was impaired in all recipients whereas donors showed peripheral flows abnormalities with similar mortality rate in both groups.
P05.26 Early correction of polyuria in recipients following laser treatment in twin–twin transfusion syndrome assessed by 3D ultrasound M. Yamamoto1 , B. Nasr2 , M. Nassar2 , L. Ortqvist2 , F. Huard2 , Y. Ville2 Clinica Alemana, Universidad del Desarrollo, Chile, 2 Centre Hospitalier Intercommunal de Poissy St Germain en Laye, France
Poster abstracts
objective was to evaluate the prognostic value of fetal diuresis within 12 hours following laser treatment in TTTS. Methods: 48 consecutive FFTS cases were included. They all underwent selective laser-coagulation of the chorionic plate anastomoses. 3D vocal was used to evaluate fetal diuresis by measuring the difference in bladder volume divided by the time interval between measurements. Donors and recipients were evaluated every 2 hours up to 12 hours after laser. Results: There were 63% survival and 77% had at least one survivor. 8 fetuses died in the first twelve hours. Diuresis did not increase in any of the donors within the first 12 hours. Diuresis decreased in recipients within 12 hours and from as early as two hours (27.2 to 15.7, p < 0.001 Wilcoxon paired test). In 5 cases that developed recurrence 4 to 11 days following laser, recipients’ diuresis was significantly higher before and 2 to 12 hours following laser (Mann Whitney all p < 0.05). Persistent polyuria (> 20 ml/K/h) in the recipient 2 hours after surgery could predict 4/5 cases with recurrence of FFTS within 11 days. Conclusion: Fetal polyiuria in recipients evaluated with 3D vocal technique is corrected as early as 2 hours after laser. Persitence of polyuria is predictive of recurrence.
P 06 : F E T A L T H E R A P Y / A N E M I A
P06.01 Pregnancy outcome in Rh alloimmunized patients managed by Doppler velocimetry of middle cerebral artery and hydrops fetalis L. Eslamian, V. Marsoosi, A. Jamal Shariati Hospital Tehran University of Medical Sciences, Islamic Republic of Iran Objective: Perinatal results of Rh alloimmunized patients; April 2004-March 2006. Methods: Descriptive observational study. The study involved pregnant women with isoimmunization or hydrops fetalis. The isoimmunized women were managed with fetal middle cerebral artery Doppler velocimetry to evaluate fetal anemia. Intravascular intrauterine transfusion (IUT) was performed in anemic fetuses as well for hydropic cases when referred. Obstetrics and neonatal variables analyzed were: IUT, mode and timing of delivery, birthweight, need for neonatal transfusion, neonatal hematocrit and perinatal mortality. Results: There were 15 cases of isoimmunization and 12 cases of hydrops fetalis. The mean age of mothers was 31.5 years (27–36). The mean gravidity was 5 (4–7) and parity 3 (1–6). The gestational age at first visit was 16-33 weels.
IUT Cesarean delivery gestaional age at delivery < 37 Mean neonatal hematocrit Neonatal transfusion Perinatal mortality: Fetal death Neonatal death
Isoimmunisation (15)
Hydrops fetalis (12)
15 (1–2/case) 11 (73.3%) 3 (20%) 33% 15
42 (3–5 case) 5 (41.66%) 10 (83%) 41% 17
1 (6.6%) 1 (6.6%)
7 (58.34) 0 (0%)
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Objective: Fetal polyuria in the recipient twin is the main diagnostic ultrasound feature in twin-to-twin-transfusion syndrome. The
Ultrasound in Obstetrics & Gynecology 2006; 28: 512–614
Conclusion: The outcomes were more favorable in nonhydropic fetuses and Doppler velocimetry of middle cerebral artery had a high sensitivity for diagnosis of anemia.
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