Assessment of the peak systolic velocity of the middle cerebral artery in twin-twin transfusion syndrome. Part I: preoperative assessment.
OBJECTIVE
We sought to assess the incidence of an elevated peak systolic velocity of the middle cerebral artery (MCA-PSV) in twin-twin transfusion syndrome prior to laser surgery and its prognostic value for intrauterine fetal demise 24 hours after surgery (IUFD-24).


METHODS
An elevated MCA-PSV was defined as a velocity > .5 multiples of the median by transabdominal pulsed Doppler. Gestational age, Quintero stage, and number and/or type of placental vascular anastomoses were assessed as risk factors for an elevated MCA-PSV. Risk of IUFD-24 was assessed relative to an elevated MCA-PSV.


RESULTS
An elevated MCA-PSV was present in 4.2% of donors, 3.2% of recipients (P = .5), and 1.5% of both twins in 189 patients with twin-twin transfusion syndrome. An elevated MCA-PSV was unrelated to gestational age, stage, and number or type of anastomoses. An elevated MCA-PSV in the recipient twin was associated with an increased risk of IUFD-24 of this fetus (P = .01).


CONCLUSIONS
An elevated MCA-PSV is present in < 5% of donor and recipient twins. An elevated MCA-PSV is a risk factor for IUFD-24 of the recipient twin.
Kontopoulos
Eftichia V
EV
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA.
Quintero
Rubén A
RA
D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005333:Fetus; D006801:Humans; D017075:Laser Coagulation; D016015:Logistic Models; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011247:Pregnancy; D014430:Twins, Monozygotic; D018608:Ultrasonography, Doppler