Role of ultrasound markers in the first trimester for predicting twin-to-twin transfusion syndrome in monochorionic twins

Abstract

T.V. Markova1, N.V. Kosovtsova1, S.Yu. Shumakov2, T.V. Chumarnaya3, E.M. Ermak4, Ya.Yu. Pospelova1 1Ural Research Institute for Maternal and Infant Health, Yekaterinburg, Russian Federation 2Regional Perinatal Center, Chelyabinsk, Russian Federation 3Institute of Immunology and Physiology of the Ural Branch of the RAS, Yekaterinburg, Russian Federation 4South Ural State Medical University, Chelyabinsk, Russian Federation Aim: to evaluate the relevance of ultrasound markers in the first trimester of pregnancy for predicting twin-to-twin transfusion syndrome (TTTS) in monochorionic twins. Patients and Methods: this prospective study was conducted from January 2016 to September 2022 and involved 178 women with monochorionic diamniotic twins in the first trimester (11+0–14+0 weeks) who underwent ultrasound once every 2 weeks. Group 1 included women who were later diagnosed with TTTS (n=68). Group 2 included women without TTTS (n=110). Results: in women who later developed TTTS, a significant increase in the discordance of the nuchal translucency (NT) thickness (p=0.036), increase in the pulsatile index (PI) of blood flow in the ductus venosus in one fetus higher than normative (p=0.036), a significant difference in the difference in the crown-rump length (CRL) (p=0.046), large arterial anastomosis in the placenta with predominant signal on one side of the isoline, and chorion previa (CP) (p=0.012) were reported. The difference in isovolumic relaxation time (IVRT) in the first trimester was more than 9 (6–11) ms in the TTTS group and 5 (4–9) ms in the non-TTTS group. However, this difference was insignificant (p=0.06). A prognostic model of TTTS was built based on ultrasound signs (NT thickness, CRL, IVRT, ductus venosus PI) using logistic regression. Conclusion: our study revealed risk factors for TTTS at the end of the first trimester in monochorionic twins. However, these risk factors require further evaluation in a large prospective case series of monochorionic twins. A method for predicting severe complications of monochorionic twins during early pregnancy provides an additional option for stratifying patients. Keywords: multiple pregnancy, monochorionic twins, twin-to-twin transfusion syndrome, first trimester ultrasound markers, nuchal translucency thickness, crown rump length, ductus venosus pulsatility index, placental anastomosis, isovolumic relaxation time. For citation: Markova T.V., Kosovtsova N.V., Shumakov S.Yu., Chumarnaya T.V., Ermak E.M., Pospelova Ya.Yu. Role of ultrasound markers in the first trimester for predicting twin-to-twin transfusion syndrome in monochorionic twins. Russian Journal of Woman and Child Health. 2023;6(3):226–232 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-2.