Amanda Henry1,2,3, Saranya Gopikrishna1, Aditi Mahajan1,4, Jennifer Alphonse1, Neama Meriki5,6, Alec W Welsh1,3. 1. a School of Women's and Children's Health , UNSW Medicine, UNSW , Sydney , Australia. 2. b Department of Women's and Children's Health , St. George Hospital , Sydney , Australia. 3. c Department of Maternal Fetal Medicine , Royal Hospital for Women , Sydney , Australia. 4. d Royal Prince Alfred Hospital , Camperdown, Sydney , Australia. 5. e Department of Obstetrics and Gynaecology, College of Medicine , King Saud University , Riyadh , Saudi Arabia. 6. f Maternal Fetal Medicine , King Khalid University Hospital , Riyadh , Saudi Arabia.
Abstract
AIMS: Assess clinical utility of the foetal Myocardial Performance Index (MPI) in evaluation and management of monochorionic, diamniotic twin (MCDA) pregnancies. METHODS: Prospective cohort of (a) initially uncomplicated MCDA (b) Complicated MCDA, including twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and liquor and/or growth discordance (L/GD) not meeting TTTS or sIUGR criteria. TTTS and sIUGR were case-control matched. Routine Dopplers and MPI were taken and correlated to diagnosis and final outcome. RESULTS: Twenty-six always uncomplicated pairs, 51 always complicated pairs, and seven uncomplicated to pathological pairs were included. TTTS recipient (n = 25) left and right MPI and intertwin difference (ITD) were significantly elevated, however, were already elevated in Stage I (n = 10), and did not predict progression or pregnancy outcome. sIUGR MPI (n = 11) did not differ significantly from control. Of 15-L/GD pairs, two that progressed to TTTS had significantly higher left and right MPI values in the future recipient (0.61 and 0.72) versus future sIUGR larger twins (0.48 and 0.51) or stable L/GD (0.47 and 0.52): p < .01 for all comparisons. CONCLUSIONS: In this cohort, MPI did not add substantial diagnostic/prognostic information to current routine evaluation in established TTTS or sIUGR though potentially differentiated L/GD cases progressing to TTTS.
AIMS: Assess clinical utility of the foetal Myocardial Performance Index (MPI) in evaluation and management of monochorionic, diamniotic twin (MCDA) pregnancies. METHODS: Prospective cohort of (a) initially uncomplicated MCDA (b) Complicated MCDA, including twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and liquor and/or growth discordance (L/GD) not meeting TTTS or sIUGR criteria. TTTS and sIUGR were case-control matched. Routine Dopplers and MPI were taken and correlated to diagnosis and final outcome. RESULTS: Twenty-six always uncomplicated pairs, 51 always complicated pairs, and seven uncomplicated to pathological pairs were included. TTTS recipient (n = 25) left and right MPI and intertwin difference (ITD) were significantly elevated, however, were already elevated in Stage I (n = 10), and did not predict progression or pregnancy outcome. sIUGR MPI (n = 11) did not differ significantly from control. Of 15-L/GD pairs, two that progressed to TTTS had significantly higher left and right MPI values in the future recipient (0.61 and 0.72) versus future sIUGR larger twins (0.48 and 0.51) or stable L/GD (0.47 and 0.52): p < .01 for all comparisons. CONCLUSIONS: In this cohort, MPI did not add substantial diagnostic/prognostic information to current routine evaluation in established TTTS or sIUGR though potentially differentiated L/GD cases progressing to TTTS.
Authors: Manon Gijtenbeek; Sanne J Eschbach; Johanna M Middeldorp; Frans J C M Klumper; Femke Slaghekke; Dick Oepkes; Monique C Haak Journal: Prenat Diagn Date: 2021-06-17 Impact factor: 3.242