Hepatic arterial buffer response in monochorionic diamniotic pregnancies with twin-to-twin transfusion syndrome
- Resource Type
- research-article
- Authors
- Cruz, Jader de Jesus; Bernardeco, Joana; Cohen, Alvaro; Serrano, Fatima
- Source
- Journal of Perinatal Medicine. 51(4):517-523
- Subject
- fetal Doppler
fetal liver hemodynamic
hepatic artery
hepatic buffer
monochorionic twin pregnancy
twin to twin transfusion syndrome
- Language
- English
- ISSN
- 0300-5577
1619-3997
Objectives Hepatic arterial buffer response (HABR) is an important regulatory process for hepatic blood flow. Its activity has been described in some fetal adverse conditions but in twin-to-twin transfusion syndrome (TTTS) it is unknown if such response is present. The aim of this study is to test the hypothesis that HABR operates in monochorionic diamniotic twins (MCDA) with TTTS. Methods Hepatic artery pulsatility index (PI) and peak systolic velocity (PSV) were measured prospectively in 64 MCDA pregnancies. 43 without TTTS (group 1) and in 21 pregnancies with TTTS (group 2). We calculated ratios for PI (HAPI-ratio) and PSV (HAV-ratio) between recipient and donor in group 2 or bigger and smaller fetus in group 1 and compared groups. The association of HAV-ratio and HAPI ratio with TTTS, relation with other fetal Dopplers and reliability of measurement by a single operator were investigated. Results HAV-ratio and HAPI-ratio appears to be independent from fetal Dopplers, estimated weight and gestational age. In group 2, HAV-ratio is lower than group 1 (p Conclusions Monochorionic pregnancies with TTTS are associated with lower HAV-ratios. This could be explained by an active HABR.