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[Fetal blood circulation in multiple pregnancy]
1Aacheni RWTH, Orvostudományi Kar, Szülészeti és Nögyógyászati Klinika.
Blood flow velocity waveforms in maternal uterine and fetal umbilical, middle cerebral and renal arteries were studied utilizing color coded pulsed Doppler ultrasound in 31 twin and 3 triplet gestations during the last trimester. Thirty-one (45.6%) out of 68 neonates were born with appropriate body weight for gestational age. Thirty-seven (54.4%) babies were small for gestational age. Of the last mentioned 37 infants 15 were small as a result of placental insufficiency. The remaining 22 babies were growth retarded due to other causes. Their resistance indices were slightly higher than in the controls in all of the investigated blood vessels. In the group of growth retarded babies due to placental insufficiency, the resistance indices of the umbilical arteries were significantly higher than those of controls (0.77 +/- 0.19 vs. 0.61 +/- 0.04). In contrast the resistance index values of the middle cerebral arteries were lower (0.70 +/- 0.05 vs. 0.79 +/- 0.11). The authors conclude that these data indicate brain sparing effect associated with placental insufficiency both in concordant and discordant growth retarded twins and triplets. This phenomenon is similar to the blood flow redistribution that occurs in growth retarded singletons in connection with placental insufficiency.
Blood flow velocity waveforms in maternal uterine and fetal umbilical, middle cerebral and renal arteries were studied utilizing color coded pulsed Doppler ultrasound in 31 twin and 3 triplet gestations during the last trimester. Thirty-one (45.6%) out of 68 neonates were born with appropriate body weight for gestational age. Thirty-seven (54.4%) babies were small for gestational age. Of the last mentioned 37 infants 15 were small as a result of placental insufficiency. The remaining 22 babies were growth retarded due to other causes. Their resistance indices were slightly higher than in the controls in all of the investigated blood vessels. In the group of growth retarded babies due to placental insufficiency, the resistance indices of the umbilical arteries were significantly higher than those of controls (0.77 +/- 0.19 vs. 0.61 +/- 0.04). In contrast the resistance index values of the middle cerebral arteries were lower (0.70 +/- 0.05 vs. 0.79 +/- 0.11). The authors conclude that these data indicate brain sparing effect associated with placental insufficiency both in concordant and discordant growth retarded twins and triplets. This phenomenon is similar to the blood flow redistribution that occurs in growth retarded singletons in connection with placental insufficiency.