title: [Complex umbilical cord vein pulsations in cases with twin-twin transfusion syndrome: prognostic implications].
abstract: OBJECTIVE
  Umbilical vein pulsations (UV-P) are due to various etiologies. The aim of the present study was to investigate the incidence and type of UV-P in monochorionic twins with twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  TTTS cases diagnosed between 1999 and 2009 were examined retrospectively. The UV flow pattern taken from a free floating loop of the umbilical cord was classified as "non-pulsatile" (NP), "monophasic" (MP) and "complex" (CP). Only Doppler flow analyses prior to intervention were examined.
  
  
  RESULTS
  Of 106 cases seen during the study period, 56 cases met the inclusion criteria. Of those, 62.5% were classified as stage III TTTS, and fetoscopic laser therapy was performed in 45 cases. NP flow patterns were more likely found in the donor twin (80.4 vs. 28.6%; p < 0.0001), while the incidence of MP (50 vs. 17.9%; p < 0.0006) and CP flow patterns (21.4 vs. 1.7%; p < 0.01) was higher in the recipient twin. Moreover, the perinatal mortality was highest in cases with CP (CP: 76.9 vs. MP 42.1 vs. NP: 26.2%; p < 0.01) as well as the rate of cases with double death.
  
  
  CONCLUSIONS
  CP patterns are more frequently found in the recipient twin and are associated with a considerably high mortality rate. Studying the umbilical vein flow pattern in TTTS may provide additional information for counseling and prognosis similar to that obtained by expensive fetal echocardiography.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Bern, Inselspital Switzerland, Bern, Schweiz. katrin.scheibner@insel.ch
authors.forename: K
authors.initials: K
authors.lastname: Scheibner
authors.forename: P
authors.initials: P
authors.lastname: Kuhn
authors.forename: D
authors.initials: D
authors.lastname: Surbek
authors.forename: L
authors.initials: L
authors.lastname: Raio
mesh_terms: D000025:Abortion, Eugenic; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D005332:Fetoscopy; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007231:Infant, Newborn; D017075:Laser Coagulation; D007752:Obstetric Labor, Premature / Q000000981:diagnostic imaging / Q000401:mortality; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011379:Prognosis; D011673:Pulsatile Flow / Q000502:physiology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014471:Umbilical Veins / Q000000981:diagnostic imaging*