Maternal and foetal haemodynamics assessment to predict IUGR in twin pregnancies

Objective. The aim of this study was to evaluate maternal haemodynamics and umbilical vein blood flow (QUV) in twin pregnancies between 24 and 28 weeks to identify possible pre­dictors for FGR twin at birth.
Materials and Methods. 21 twin pregnancies, 10 mono­chorionic diamniotic and 11 dichorionic diamniotic, be­tween 24 and 28 weeks were included in this study (n = 42 foetuses). Among these, 36 foetuses were AGA at birth and 6 developed FGR. All patients underwent a non-invasive maternal haemodynamics assessment us­ing an Ultrasound Cardiac Output Monitor (USCOM®) and a complete foetal haemodynamic examination in­cluding QUV.
Results. in comparison with AGA, QUV and corrected for es­timated foetal weight QUV (cQUV) were significantly lower in FGR foetuses between 24 and 28 weeks. Additionally, maternal cardiac output (CO) and inotropy index (iNO) were significant­ly lower in FGR, while systemic vascular resistance (SVR) was higher. According to ROC analysis, QUV centile (cut off ≤ 23 cen­tile, AUC 0.90, 95%CI 0.76-0.97) and SVR (> 814 dynes × sec/ cm5, AUC 0.85, 95%CI 0.71-0.94) are the best predictors for FGR in twin pregnancy between 24 and 28 weeks, also shown by mul­tivariate logistic regression analysis (AUC 0.94, 95%CI 0.83-0.99).
Conclusions. QUV and maternal haemodynamics evaluation can be useful tools to identify twin pregnancies with a higher risk to develop FGR twin