Zarean Elaheh, Farahbod Farinaz, Khanjani Somayeh, Zanbagh Leila, Tarrahi Mohammad Javad, Veisian Mehrnaz
Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
J Res Med Sci. 2023 May 29;28:41. doi: 10.4103/jrms.jrms_446_22. eCollection 2023.
Monochorionic diamniotic (MCDA) twin pregnancies are considered high-risk for several reasons, especially the risk of twin-to-twin transfusion syndrome (TTTS). Renal artery Doppler (RAD) is reported as a useful tool for predicting oligohydramnios in singleton pregnancies. We aimed to compare the RAD indices between MCDA twins with and without TTTS.
In this case-control study, all pregnant women aged 18-38 years, with gestational age ≥ 18 weeks, who were referred to two Prenatal Clinics, Alzahra and Beheshti Educational Hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, October 2020-March 2022 were enrolled; the women with MCDA twin pregnancies complicated by TTTS (case group, = 12) and without TTTS (control group, = 24). For each twin, biometric analysis, fetal weight, and Doppler study of fetal arteries, including RAD, middle cerebral artery (MCA), umbilical artery, and ductus venosus were performed. Peak systolic velocity, Pulsatility index (PI), resistance index (RI), and systole/diastole (S/D) were measured for all arteries.
The donors of the case group had a lower mean MCA S/D (4.48 ± 1.89) than the control group (6.48 ± 1.97) ( = 0.01) and higher mean umbilical parameters, including PI, RI, and S/D ( < 0.05). The recipients of the case group had a lower mean renal PI than the control ( = 0.008) and lower mean MCA PI, RI, and S/D ( < 0.05). The donor group had a higher mean umbilical RI and S/D than the recipient twin, while the mean fetal weight of the recipient group was higher ( < 0.05).
Comparing the RAD parameters between the twins with and without TTTS in the present study did not identify significant results, which rejected the primary hypothesis. Among all RAD parameters, the only significant difference observed in the present study was the lower RAD PI in RT, which cannot suggest this measurement as a valuable tool for the prediction of TTTS in MCDA twins. Therefore, the results of the present study failed to show the additional value of RAD, compared with the conventional Doppler examination of fetal arteries. Further studies are required to prove this conclusion.
单绒毛膜双羊膜囊（MCDA）双胎妊娠因多种原因被视为高危妊娠，尤其是双胎输血综合征（TTTS）的风险。肾动脉多普勒（RAD）被报道为预测单胎妊娠羊水过少的有用工具。我们旨在比较有无TTTS的MCDA双胎之间的RAD指标。
在这项病例对照研究中，纳入了2020年10月至2022年3月转诊至伊朗伊斯法罕医科大学附属的阿尔扎赫拉和贝赫什提教育医院两家产前诊所的所有年龄在18 - 38岁、孕周≥18周的孕妇；患有合并TTTS的MCDA双胎妊娠的妇女（病例组，n = 12）和未患TTTS的妇女（对照组，n = 24）。对每个胎儿进行生物测量分析、胎儿体重测量以及胎儿动脉的多普勒研究，包括RAD、大脑中动脉（MCA）、脐动脉和静脉导管。测量所有动脉的收缩期峰值流速、搏动指数（PI）、阻力指数（RI）和收缩期/舒张期（S/D）。
病例组的供血儿平均MCA S/D（4.48 ± 1.89）低于对照组（6.48 ± 1.97）（P = 0.01），脐部参数平均值更高，包括PI、RI和S/D（P < 0.05）。病例组的受血儿平均肾PI低于对照组（P = 0.008），平均MCA PI, RI和S/D也更低（P < 0.05）。供血儿组的平均脐部RI和S/D高于受血儿，而受血儿组的平均胎儿体重更高（P < 0.05）。
在本研究中，比较有无TTTS的双胎之间的RAD参数未得出显著结果，这否定了原假设。在所有RAD参数中，本研究中观察到的唯一显著差异是受血儿的RAD PI较低，这不能表明该测量可作为预测MCDA双胎TTTS的有价值工具。因此，与传统的胎儿动脉多普勒检查相比，本研究结果未能显示RAD的额外价值。需要进一步研究来证实这一结论。
