[Discordant growth in twin pregnancy--value of Doppler ultrasound]

A 4 MHz continuous-wave Doppler device was used to study uterine and umbilical arterial wave forms in 91 pairs of twins between 18th and 40th week of gestation. Biometry and cord localisation were effected by real-time ultrasound. The results of 182 Doppler flow examinations showed that umbilical flow velocimetry may prove relevant for early identification of twin pregnancies with discordant growth. Depending on the interval between examination and delivery, sensitivity and specificity values between 44% and 66%, and 66% and 73%, respectively, were obtained. A high resistance index in umbilical arteries was indicative of intrauterine growth retardation, at a specificity of 69% and a sensitivity of 44%. For uteroplacental as well as foetoplacental flow velocity waveform assessment, singleton reference values may be used, whereas, by reason of its low sensitivity, Doppler flow velocimetry does not lend itself as a primary diagnostic tool for intrauterine growth retardation. It can signal pathologic blood flow profiles, which are often associated with added risks, such as pregnancy-induced hypertension, foetal acidosis and stillbirth and can contribute to early detection of twin pregnancies that require close clinical and cardiotocographic surveillance.