ABSTRACT
Double umbilical pulsatile venous flow is a rare event generally associated with fetal right heart failure. We observed, at 21 weeks' gestation, this venous flow pattern in a case of twin-twin transfusion syndrome occurring in the recipient twin affected by severe hydrops. In spite of a spontaneous remission of fetal hydrops at 30 weeks, the fetus died suddenly in utero, 2 weeks later. We hypothesized that this unexpected event was related to reversed acute twin-twin transfusion, and concluded that fetal hydrops remission in twin-twin transfusion syndrome must not be considered as a reassuring prognostic index but as an indication of the need for continuing biophysical monitoring.
Subject(s)
Fetofetal Transfusion/physiopathology , Umbilical Veins/physiopathology , Adult , Blood Flow Velocity , Female , Fetal Death , Fetofetal Transfusion/diagnostic imaging , Gestational Age , Humans , Hydrops Fetalis/diagnostic imaging , Hydrops Fetalis/physiopathology , Pregnancy , Pulsatile Flow , Remission, Spontaneous , Twins, Monozygotic , Ultrasonography, Doppler , Ultrasonography, Prenatal , Umbilical Veins/diagnostic imaging , Vena Cava, Inferior/physiopathologyABSTRACT
The accurate assessment of gestational age is very important in everyday practice. By the use of multiple regression analysis, in a longitudinal study, ultrasound dating-curves were calculated for the crown-rump length, biparietal diameter, femur length, humerus length, binocular distance and transverse cerebellar diameter. All the examined parameters showed a good statistical correlation with gestational age; however, the earlier the estimation of the gestational age, the more accurate it is. The crown-rump length has been shown as the best parameter during the first trimester. Later on, the other biometric parameters become easier and more reliable. If determination of gestational age is required during the third trimester, the use of multiple parameters is recommended.
