title: Fetal hemodynamic changes following maternal betamethasone administration in monochorionic twin pregnancies featuring one twin with selective growth restriction and abnormal umbilical artery Doppler.
abstract: OBJECTIVE
  To evaluate fetal hemodynamic changes following maternal betamethasone administration in monochorionic twin pregnancies featuring one twin with selective intrauterine growth restriction (sIUGR) and absence of end-diastolic velocity in umbilical artery (UA) Doppler.
  
  
  METHODS
  sIUGR was defined as fetal weight below the 10th percentile in one twin and inter-twin birth weight discordance >25%. The results of Doppler examinations including UA, middle cerebral artery (MCA) and ductus venosus directly prior to (D0), at 24 h (D1) and 48 h (D2) after administration of the first dose of betamethasone were recorded. Cerebral-placenta ratio was defined as MCA pulsatility index (PI) divided by UA-PI.
  
  
  RESULTS
  In four (20%) of the 20 cases, the UA Doppler of the growth-restricted twin returned to positive end-diastolic velocity after betamethasone administration. The UA-PI and MCA-PI of the sIUGR twin changed significantly after betamethasone administration: UA-PI was decreased at D1, the MCA-PI was reduced at both D1 and D2, and the cerebral-placenta ratio was not altered after betamethasone administration in the sIUGR twin.
  
  
  CONCLUSIONS
  The hemodynamic changes after betamethasone administration were different between the two monochorionic twin fetuses where one presented with sIUGR and absence of UA end-diastolic velocity. The etiology of a low rate of return of end-diastolic velocity in the sIUGR twin needs further evaluation.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. j12054@cgmh.org.tw
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Chang
authors.forename: Shuenn-Dyh
authors.initials: SD
authors.lastname: Chang
authors.forename: An-Shine
authors.initials: AS
authors.lastname: Chao
authors.forename: Peter C C
authors.initials: PC
authors.lastname: Hsieh
authors.forename: Chao-Nin
authors.initials: CN
authors.lastname: Wang
authors.forename: Tzu-Hao
authors.initials: TH
authors.lastname: Wang
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000494:pharmacology / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000187:drug effects*; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D011247:Pregnancy; D059285:Pregnancy, Twin; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone