title: Evaluation of cardiac performance by abdominal fetal ECG in twin-to-twin transfusion syndrome.
abstract: OBJECTIVE
  To investigate fetal cardiac performance by abdominal fetal electrocardiography (ECG) in monochorionic diamniotic pregnancies with twin-to-twin transfusion syndrome (TTTS-MCDA).
  
  
  METHODS
  Abdominal fetal ECG was attempted in 16 singleton, 21 non-TTTS-MCDA, and 14 TTTS-MCDA pregnancies at 16-27 weeks' gestation. Standard ECG parameters were compared across study groups and evaluated for their correlation with Doppler ultrasound indices.
  
  
  RESULTS
  Clear P-QRST complexes were recognized in all cases. In the TTTS-MCDA pregnancies, the QT interval and QTc were significantly longer than in both singletons and the non-TTTS-MCDA pregnancies (p = 0.002 and p = 0.0002, respectively), whereas in the recipient fetus, both the PR interval and PR/RR were significantly longer when compared with all other study groups (p = 0.019 and p = 0.012, respectively). Further comparison with Doppler ultrasound indices yielded significant reciprocal correlations between ductus venosus pulsatility index and the QT interval (r = 0.552, p = 0.041) and between umbilical artery pulsatility index and PR/RR (r = 0.654, p = 0.011) both demonstrated in recipient fetuses alone.
  
  
  CONCLUSIONS
  Abdominal fetal ECG is feasible in second-trimester twin pregnancies. In TTTS, there is evidence of a higher risk of cardiac dysfunction in the recipient twin.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, London, UK. chinkeyvelayo@med.tohoku.ac.jp
authors.forename: Clarissa
authors.initials: C
authors.lastname: Velayo
authors.forename: Jesus Rodriguez
authors.initials: JR
authors.lastname: Calvo
authors.forename: Naoaki
authors.initials: N
authors.lastname: Sato
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kimura
authors.forename: Nobuo
authors.initials: N
authors.lastname: Yaegashi
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaides
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D015148:Cardiotocography / Q000379:methods*; D015150:Echocardiography, Doppler; D004562:Electrocardiography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000503:physiopathology*; D005330:Fetofetal Transfusion / Q000503:physiopathology*; D005865:Gestational Age; D006321:Heart / Q000503:physiopathology*; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis / Q000379:methods*; D062606:Tertiary Care Centers; D014430:Twins, Monozygotic