ABSTRACT
OBJECTIVE: To evaluate the clinical utility of Doppler velocimetry as a comprehensive test for the prediction of discordant twins. DESIGN: Prospective clinical study. SETTING: Department of Gynecology and Obstetrics, Charles University Hospital, Hradec Králové, Czech Republic. METHODS: Biometrical measurements and Doppler velocimetry of umbilical artery (UA) and middle cerebral artery (MCA) were performed in twins in third trimester. Intertwin differences in biometrical parametres delta BPD, delta AC, delta FL, delta EFW and in pulsality indexes of studied vessels delta UA a delta MCA were expressed. Discordance was identified by the birth weight difference from 20%. Studied parameters were evaluated using ROC analysis. RESULTS: Among the 63 sets of twins studied, 33 pars fulfilled the study criteria. 21 pars were bichorionic, 7 monochorionic and 5 with unknown chorionicity. Ten sets of twins were discordant (303%). The mean gestational age at delivery was 35.9 +/- 1.7 weeks. Overall the best discordancy predictor was delta EFW with sensitivity and specificity values of 100% and 95.7%, respectively, for the cut-off value delta EFW 17.9%. The more accurate one of doppler parameters was MCA, with sensitivity and specificity values of 85.7% and 77.9%, respectively, for the cut-off value delta MCA 25%. UA had senzitivity and specificity 70% and 47.8%, respectively, for most suitable cut-off value delta UA 16.7%. CONCLUSION: It is possible to predict the discordant twins birth using middle cerebral artery Doppler velocimetry, but the EFW assessment remains the most accurate method. Umbilical artery Doppler velocimetry did not appeared as effective.
Subject(s)
Fetal Development , Pregnancy, Multiple , Twins , Ultrasonography, Doppler , Ultrasonography, Prenatal , Blood Flow Velocity , Female , Gestational Age , Humans , Middle Cerebral Artery , Pregnancy , Pregnancy Trimester, Third , Sensitivity and Specificity , Umbilical ArteriesABSTRACT
TYPE OF STUDY: Case report. SETTING: Department of Gynecology and Obstetrics, Department of Radiology, Department of Pathology, Department of Medical Genetics, Charles University Hospital, Hradec Králové. METHODS: The autors report a case of renal tumor in a fetus at 33 weeks of gestation detected by means of ultrasonography and magnetic resonance imaging. The pregnancy course was complicated by polyhydramnios. The female infant was born vaginally at 37 weeks of gestation. Postnatal nephrectomy confirmed prenatal diagnostic presumption - congenital mezoblastic nephroma. At follow-up at 12 months of age, the infant had no evidence of the disease. CONCLUSION: Detection of renal tumor in a fetus is rare. Congenital mezoblastic nephroma with the favourable prognosis is most probable diagnosis. Prenatal detection enables the prevention of complications (prematurity prevention, detection of the developing cardial decompensation and fetal hydrops) with the planning of labour and postnatal management.
