Diastolic zero-flow in the umbilical artery in twin pregnancies

Clinical arterial blood flow measurements in single pregnancies can not be precisely estimated yet. ARED (absent or reverse end diastolic) flow of the umbilical artery (UA) commonly indicates a symptom of fetal jeopardy. The interpretation of blood flow measurement in twin pregnancies is still controversial. On one hand, no differences in a single pregnancies are found, and on the other hand, increased resistance indices have been reported. In the feto-fetal transfusion syndrome mostly there are normal blood flow measurements. When pathological blood flow occurs, usually it affects the donor. By means of 4 case reports with ARED flow, the value of the investigation method in management of twin pregnancies is demonstrated. Three out of four fetuses with an ARED flow in the UA have died. Case fetus with a normal flow velocimetry survived. Even feto-fetal transfusion syndrome may cause pathological blood flow curves. In fetuses with ARED-flow in the UA fetal hypoxia and acidosis are to be expected. A careful evaluation of the cardiotocogram is indicated with a viable fetus. A possible fetal disturbance may be seen early in blood flow curves and may help provide better obstetrical management.