Predictive value of fetal mortality by the Ductus Venosus Doppler in Feto-Fetal Transfusion Syndrome. Metanalysis
Keywords:
Twin-to-twin transfusion syndrome (TTTS), Laser coagulation, Ductus venosus Doppler, Fetal mortality, Meta-analysisAbstract
Introduction: The ductus venosus (DV) is a vascular shunt located within the fetal liver parenchyma that connects the umbilical vein to the subdiaphragmatic venous vestibule. DV Doppler is used to monitor the response to fetoscopic laser surgery and in the early stratification of patients at high risk of developing twin-to-twin transfusion syndrome (TTTS).
Objective: To describe the predictive value of using Doppler of the ductus venosus (DV) in fetal mortality in patients with twin-to-twin transfusion syndrome treated with fetoscopic laser surgery.
Methods: A systematic review of articles containing information on the topic was conducted, followed by a validation process focused on the completeness of the collected information and the required homogeneity. Through a comprehensive literature review and the application of rigorous methodological criteria, various studies were selected and analyzed.
Results: An association was found between preoperative abnormal ductus venosus (DV) and fetal death in the recipient fetus after fetoscopic laser coagulation. DV abnormalities were less frequent in the donor than in the recipient twin.
Conclusions: This study demonstrates that ductus venosus Doppler is a reliable indicator for the early identification of fetuses at risk, allowing for timely clinical interventions.
Downloads
References
1. Braga M, Lúcia Moleiro M, Guedes Martins L. Clinical Significance of Ductus Venosus Waveform as Generated by Pres- sure-volume Changes in the Fetal Heart. Current Cardiology Reviews. 2019 [citado 22/02/2024];15(3):167–176. Disponible en: https://www.benthamdirect.com/content/journals/ccr/10.2174/1573403X15666190115142303
2. Matias A, Montenegro N, Areias JC, Leite LP. Haemodynamic evaluation of the first trimester fetus with special emphasis on venous return. Hum Reprod Update. 2000 [citado 22/02/2024];6(2):177-89. Disponible en: https://pubmed.ncbi.nlm.nih.gov/10782576/
3. Oh C, Harman C, Baschat AA. Abnormal first-trimester ductus venosus blood flow: a risk factor for adverse outcome in fetuses with normal nuchal translucency. Ultrasound Obstet Gynecol. 2007 [citado 22/02/2024];30(2):192-6. Disponible en: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.4034
4. Ramos Pérez E, Sánchez Lueiro M, Amador de Varona CI, Rodríguez Martínez M. Comportamiento del embarazo múltiple y sus principales indicadores perinatales. AMC. 2008 [citado 18/02/2025]; 12(4). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S102502552008000400007&lng=es.
5. Kilby MD, Bricker L. Management of Monochorionic Twin Pregnancy: Green-top Guideline No. 51. BJOG. 2025 [citado 18/02/2025];132(6):e98-e129. Disponible en: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.18055?af=R#
6. Denbow ML, Cox P, Taylor M, Hammal DM, Fisk NM. Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol. 2000;182:417–426
7. Fischbein R, Nicholas L, Aultman J, Baughman K, Falletta L. Twin-twin transfusion syndrome screening and diagnosis in the United States: A triangulation design of patient experiences. PLoS One. 2018 [citado 18/02/2025];13:e0200087. Disponible en: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0200087&type=printable
8. Lewi L, Jani J, Blickstein I, Huber A, Gucciardo L, Van Mieghem T, et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol. 2008 [citado 18/02/2025];199:514.e1-e8 Disponible en: https://www.ajog.org/article/S0002-9378(08)00345-1/fulltext
9. Tim Van M, Liesbeth L, Gucciardo L, DeKoninck P, Van Schoubroeck D, Devlieger R, et.al. The Fetal Heart in twin-to-twin transfunsion syndrome. IJP. 2010 [citado 18/02/2025]; Disponible en: https://onlinelibrary.wiley.com/doi/10.1155/2010/379792
10. Habli M, Michelfelder E, Livingston J, Harmon J, Lim FY, Polzin W, et al. Acute effects of selective fetoscopic LASER photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol 2008 [citado 18/02/2025];199:412.e1-6. Disponible en: https://www.ajog.org/article/S0002-9378(08)00699-6/fulltext
11. Karatza AA, Wolfenden JL, Taylor MJ, Wee L, Fisk NM, Gardiner HM. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart. 2002 [citado 18/02/2025];88:271–277. Disponible en: https://heart.bmj.com/content/88/3/271
12. Seravalli V, Miller JL, Block-Abraham D, Baschat AA. Ductus venosus Doppler in the assessment of fetal cardiovascular health: an updated practical approach. Acta Obstet Gynecol Scand. 2016 [citado 18/02/2025];95:635–644. Disponible en: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12893
13. Bensouda B, Fouron JC, Raboisson MJ, Lamoureux J, Lachance C, Leduc L. Relevance of measuring diastolic time intervals in the ductus venosus during the early stages of twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2007 [citado 18/02/2025];30:983–987. Disponible en: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.5161
14. Barrea C, Debauche C, Williams O, Jasienski S, Steenhaut P, Sluysmans T, et al. Twin-to-twin transfusion syndrome: perinatal outcome and recipient heart disease according to treatment strategy. J Paediatr Child Health. 2013 [citado 18/02/2025];49(1):E28-E34. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/jpc.12060
15. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19(8 Pt 1):550-555.
16. Sago H, Hayashi S, Saito M, Hasegawa H, Kawamoto H, Kato N,et.al. The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery. Prenat Diagn. 2010 [citado 18/02/2025];30(12-13):1185-91. Disponible en: https://pubmed.ncbi.nlm.nih.gov/21064193/
17. Skupski DW, Luks FI, Walker M, Papanna R, Bebbington M, Ryan G, et al. Preoperative predictors of death in twin‐to‐twin transfusion syndrome treated with laser ablation of placental anastomoses. Am J Obstet Gynecol. 2010 [citado 18/02/2025];203(4): e381‐388.e31. Disponible en: https://pubmed.ncbi.nlm.nih.gov/20691964/
18. Eixarch E, Valsky D, Deprest J, Baschat AA, Lewi L, Ortiz JU, et al. Preoperative prediction of the individualized risk of early fetal death after laser therapy in twin‐totwin transfusion syndrome. Prenat Diagn. 2013 [citado 18/02/2025];33(11):1033‐1038. Disponible en: https://pubmed.ncbi.nlm.nih.gov/23813911/
19. Sananes N, Weingertner AS, Guerra F, Kohler M, Fritz G. Predictive value of cardiovascular parameters in twin‐to‐twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014 [citado 18/02/2025];44(4):427‐433. Disponible en: https://pubmed.ncbi.nlm.nih.gov/24585420/
20. Boons LS, Wolterbeek R, Middeldorp JM, Klumper FC, Lopriore E. Prediction of single fetal demise after laser therapy for twin‐twin transfusion syndrome. Ultrasound Obstet Gynecol. 2016 [citado 18/02/2025];47(3):356‐362. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26395988/
21. Leduc F, Delabaere A, Gendron R, Fuchs F, Wavrant S, Raboisson MJ, et al. Aortic isthmus flow recording predicts the outcome of the recipient twin after laser coagulation in twin‐twin transfusion syndrome. Fetal Diagn Ther. 2017 [citado 18/02/2025];44(2): 135‐141. Disponible en: https://pubmed.ncbi.nlm.nih.gov/28918426/
22. Delabaere A, Leduc F, Reboul Q, Fuchs F, Wavrant S, Dubé J, et al. Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and Doppler ultrasound. Prenat Diagn. 2018 [citado 18/02/2025];38(7):523‐530. Disponible en: https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/pd.5280
23. So Yeon K, Seung Mi L, Keumran C, Chan-Wook P, Shin P, Kwan J. Fetal Survival Immediate after Fetoscopic Laser Ablation in Twin-to-Twin Transfusion Syndrome. J Korean Med Sci. 2019 [citado 18/02/2025]; 34(3):e20. Disponible en: https://jkms.org/DOIx.php?id=10.3346/jkms.2019.34.e20
24. Gijtenbeek M, Eschbach SJ, Middeldorp JM, Klumper F, Slaghekke F, Oepkes D, et al. The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis. Prenatal Diagnosis. 2019. [citado 18/02/2025];39(10): 838-847. Disponible en: https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/pd.5511
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Daniel Esteban Padilla Barragán, Jazmina Alexandra Moreno Vargas , Odalis Michelle Moreno Vargas
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
ACCESS AND DISTRIBUTION POLICY
All published articles are open access contributions, which are distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License which permits unrestricted non-commercial use, distribution and reproduction in any medium, provided that the primary source of publication is properly cited.
