Amniotic Fluid and Maternal Blood Characteristics in Severe Mid-Trimester Twin–Twin Transfusion Syndrome

Vol. 19, No. 6, 2004

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Paper

Amniotic Fluid and Maternal Blood Characteristics in Severe Mid-Trimester Twin-Twin Transfusion Syndrome
Agnes Huber^a, Werner Diehl^a, Liza Zikulnig^a, Karsten R. Held^b, Thomas Bregenzer^c, B.-Joachim Hackelöer^a, Kurt Hecher^a

^aDepartment of Prenatal Diagnosis and Therapy, Barmbek Hospital, Hamburg;
^bIPM Institute for Immunology, Pathology and Molecular Biology, Hamburg, and
^cPAREXEL Department of Biometry and Statistics, Westend Hospital, Berlin, Germany

Address of Corresponding Author

Fetal Diagn Ther 2004;19:504-509 (DOI: 10.1159/000080163)

Key Words

Twin-twin transfusion syndrome
Amniotic fluid composition
Ductus venosus
Laser therapy
Amniodrainage

Abstract

Objective: To investigate the concentrations of metabolic variables in the amniotic fluid of the recipient twin and maternal blood and to correlate them with clinical features, which are characteristic for the course of pregnancies with twin-twin transfusion syndrome (TTS). Materials and Methods: In 109 pregnancies with severe mid-trimester TTS, we measured the concentrations of interleukin-6 (IL-6), alpha -fetoprotein (AFP), sodium, potassium, total protein, beta ₂-microglobulin and osmolality in the amniotic fluid of the recipient twin prior to laser coagulation of the vascular anastomoses and compared them to a control group of 92 singleton pregnancies. We measured the pulsatility index (PI) of ductus venosus flow velocity waveforms in the recipient twin and performed a retrospective chart analysis for complete maternal blood count before and after the procedure. Results: All variables, except osmolality, IL-6 and AFP were significantly lower in the TTS group. There was a significant positive correlation between PI in the ductus venosus and the amniotic fluid AFP concentrations (r = 0.355; p < 0.001). There was a significant fall in complete maternal blood count after laser therapy (p < 0.001) and a significant correlation between the amount of amniotic fluid drained and the fall of maternal Hb (r = -0.261; p = 0.03) and hematocrit (r = -0.212; p = 0.01). Conclusion: Pathophysiologic changes in TTS do not only occur at the inter-twin level of placental vascular anastomoses but also at the materno-fetal level of fluid exchanges. AFP is correlated to the severity of congestive heart failure of the recipient twin.

Author Contacts

Kurt Hecher, MD
Department of Obstetrics and Fetal Medicine
Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52
DE-20246 Hamburg (Germany)
Tel. +49 40 42803 7832, Fax +49 40 42803 6767, E-Mail KHecher@uke.unihamburg.de

Article Information

Received: June 5, 2003
Accepted after revision: October 6, 2003
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 2, Number of References : 24

Medline Abstract (ID 15539875)

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