POTENTIAL VALUE OF FETAL ECHOCARDIOGRAPHY IN THE DIFFERENTIAL-DIAGNOSIS OF TWIN PREGNANCY WITH PRESENCE OF POLYHYDRAMNIOS-OLIGOHYDRAMNIOS SYNDROME

OBJECTIVE: Our purpose was to establish whether index values of cardia c performance could discriminate between the twin-twin transfusion syn drome and placental insufficiency as the etiology of the polyhydramnio s-oligohydramnios sequence in monochorionic diamniotic twins. STUDY DE SIGN: Thirteen monochorionic diamniotic twin pregnancies with ultrason ographic evidence of polyhydramnios-oligohydramnios sequence had a com plete echocardiography. The etiology was confirmed postnatally: placen tal insufficiency in eight pairs and the twin-twin transfusion syndrom e in five. Intertwin comparisons were made for the following cardiac p arameters: cardiothoracic index, end-diastolic thickness of the ventri cular wails and septum, aortic and pulmonary artery Doppler peak veloc ities, ejection and acceleration times, left ventricular shortening fr action, and combined cardiac output and output indexed to fetal weight . RESULTS: All five recipient twins had thickened Ventricular walls. T he left Ventricular shortening fractions and outputs were significantl y increased in the donor twin with twin-twin transfusion syndrome and normal in placental insufficiency. CONCLUSION: In twin-twin transfusio n syndrome the donor twin shows evidence of a hyperdynamic cardiac sta te. Intertwin comparison of cardiac parameters, especially the left ve ntricular shortening traction, can be considered a useful tool in diag nosing the different etiologies of the polyhydramnios-oligohydramnios sequence.