Twin fetuses: intravascular microbubble US contrast agent administration--early experience.
OBJECTIVE
To explore the feasibility of administering SH U 508A by using a single-needle procedure at ultrasonography (US) in twin pregnancies to confirm interfetal transfusion in monochorionic twins and delineate placental angioarchitecture in pregnancies with twin-twin transfusion syndrome.


METHODS
Fourteen twin pregnancies were studied over 12 months: seven with monochorionic twins, including six with twin-twin transfusion syndrome; two of unknown chorionicity; and five with known dichorionic twins discordant for fetal karyotype or anomaly and undergoing selective feticide in the third trimester. Bolus injection of 100 microL/kg of estimated fetoplacental weight of 400 mg/mL of SH U 508A was performed in the intrahepatic vein of one twin, and evidence of interfetal transfusion was sought by means of digital analysis of power Doppler signals in the contralateral twin.


RESULTS
Contralateral twin echo enhancement was seen in four of the nine ultimately histopathologically proved monochorionic twins. As expected, no evidence of echo enhancement in the contralateral twin was seen in any of the five dichorionic twin pregnancies. There was no evidence of fetal compromise associated with the procedure.


CONCLUSIONS
These pilot results suggest that microbubbles can be used to demonstrate interfetal transfusion but not to delineate placental vascular anatomy.
Denbow
M L
ML
Department of Maternal and Fetal Medicine, Imperial College School of Medicine, Queen Charlotte's & Chelsea Hospital, London, United Kingdom.
Welsh
A W
AW
Taylor
M J
MJ
Blomley
M J
MJ
Cosgrove
D O
DO
Fisk
N M
NM
D000328:Adult; D003287:Contrast Media; D004200:Diseases in Twins / Q000235:genetics; D005240:Feasibility Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000235:genetics; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007621:Karyotyping; D008297:Male; D010920:Placenta / Q000098:blood supply; D011134:Polysaccharides; D011247:Pregnancy; D014429:Twins, Dizygotic / Q000235:genetics; D014430:Twins, Monozygotic / Q000235:genetics; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal / Q000379:methods*
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508