Umbilical Venous Flow Volume and Fetal Combined Cardiac Output in Twin Pregnancies

This study aimed to establish normal reference ranges of combined cardiac output (CCO) and umbilical venous flow volume (UVFV) in twin fetuses at 20 to 28 weeks of gestation and to evaluate the differences between monochorionic and dichorionic twins. CCO and UVFV were prospectively measured by ultrasound at two centers. The following exclusion criteria were applied: age <18 years or >45 years, first hospital visit at >16 weeks of gestation, monochorionic monoamniotic twin pregnancy, fetal structural or chromosomal abnormality, fetal growth restriction, twin-twin transfusion syndrome, twin anemia polycythemia sequence, and severe hypertension or renal disease were excluded. The period was divided into three groups: 20-22 weeks of gestation, 23-25 weeks of gestation, and 26-28 weeks of gestation. The CCO and UVFV were measured at least once during each period. CCO and UVFV were collected from 274 and 269 fetuses and were measured 412 and 424 times, respectively. UVFV and CCO levels increased as gestation progressed. The weight-corrected UVFV (UVFV/kg) and CCO (CCO/kg) remained stable. UVFV and CCO did not differ between monochorionic and dichorionic twin fetuses. The mean ± SD of UVFV/kg and CCO/kg were determined as 127.8 ± 31.8 and 439.4 ± 80.1 mL/kg/min, respectively. The UVFV-to-CCO ratio also remained stable from 20 to 28 weeks of gestation, ranging from 27.7% to 31.8%. The values and ranges of UVFV/kg and mean CCO/kg in twins were similar to those in singletons.