[Doppler ultrasound in high grade multiple pregnancies]

Area of Science:

• Perinatology
• Fetal Medicine
• Diagnostic Ultrasound

Background:

• High-order multiple pregnancies pose significant risks to fetal well-being.
• Accurate monitoring is essential for timely intervention in these high-risk pregnancies.

Purpose of the Study:

• To evaluate the utility of pulsed Doppler ultrasound in monitoring high-order multiple pregnancies.
• To assess the correlation between Doppler findings and fetal growth abnormalities.

Main Methods:

• Pulsed Doppler ultrasound was used to study 16 triplets and 2 quadruplets between 17 and 36 weeks of gestation.
• Resistance index (RI) of the fetal aorta and umbilical artery was analyzed; elevated RI above the 95th percentile was considered pathological.
• Circulatory centralization was indicated by elevated umbilical artery RI compared to the middle cerebral artery.

Main Results:

• Intrauterine growth retardation (IUGR) was diagnosed in 16% of fetuses, and discordant growth in 39% of pregnancies.
• Pathological Doppler findings were more frequent indicators of IUGR or discordant growth than biometry alone.
• Doppler sonography detected 4 out of 6 cases of intrauterine endangered fetuses, with 73% of all fetuses surviving in good health.
• Four of 7 fetuses with pathological Doppler findings died, while the three survivors exhibited significant growth retardation.

Conclusions:

• Doppler sonography is a valuable complementary tool for monitoring high-order multiple pregnancies.
• Pathological Doppler findings, particularly elevated RI and signs of circulatory centralization, are important indicators of fetal compromise.
• Combining Doppler findings with biometry improves the diagnosis of IUGR and discordant growth in multiple gestations.