Doppler studies of the fetal circulation in twin–twin transfusion syndrome

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Abstract
This cross‐sectional study investigated the circulatory profile of the donor and recipient fetuses in 20 pregnancies with twin–twin transfusion syndrome presenting with acute polyhydramnios at 17–27 (mean, 22) weeks' gestation. Doppler investigations of the arterial vessels and ductus venosus, inferior vena cava, right hepatic vein, tricuspid and mitral ventricular inflow were performed in both fetuses. Mean values of most blood flow velocities on the venous side showed a significant decrease in both groups of fetuses, and a significant increase in mean values for indices describing waveform pulsatility was found in all three venous vessels in the group of recipients, whereas in the donor group this was only the case in the ductus venosus. Mean values of atrioventricular flow velocities showed a significant decrease in the donor group. The most significant findings on the arterial side were an increased mean umbilical artery pulsatility index and a decreased mean value for aortic blood flow velocity in both groups of fetuses. Five recipients and four donors had absence or reversal of blood flow during atrial contraction in the ductus venosus. All these fetuses showed pulsations in the umbilical vein. Tricuspid regurgitation was present in eight recipients. Absence or reversal of end‐diastolic velocities in the umbilical artery was found in four donors. The recipient's circulation showed the characteristics of congestive heart failure due to hypervolemia. The significant decrease of diastolic venous blood flow velocities is compatible with increased end‐diastolic ventricular pressure. Alterations in the donor's circulation are consistent with decreased venous return due to hypovolemia and increased cardiac afterload due to increased placental resistance. Copyright © 1995 International Society of Ultrasound in Obstetrics and Gynecology

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