1998 Fiscal Year Final Research Report Summary
Study on fetal growth and hemodynamics in human multiple pregnancies
| Project/Area Number |
08671902
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Obstetrics and gynecology
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| Research Institution | KYUSHU UNIVERSITY |
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Principal Investigator |
SATOH Shoji Kyushu Univ., Department of Obstet. Gynecol. Senior Lecturer, 医学部, 講師 (00225947)
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| Co-Investigator(Kenkyū-buntansha) |
TSUKIMORI Kiyomi Kyushu Univ., Department of Obstet. Gynecol. Senior Lecturer, 医学部, 講師 (90253450)
KOYANAGI Takashi Kyushu Univ., Department of Human Development, professor, 大学院・医学系研究科, 教授 (30136452)
NAKANO Hitoo Kyushu Univ., Department of Obstet. Gynecol. Professor, 大学院・医学系研究科, 教授 (40038766)
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| Project Period (FY) |
1996 – 1998
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| Keywords | human fetus / twin pregnancy / fetoplacental circulation / fetal growth / twin-twin transfusion / discordant twin / placental pathology |
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| Research Abstract |
1) To clarify whether twin fetuses could be clustered quantitatively observing in utero cardiovascular system function, 71 twin-paired fetuses between 24 and 40 weeks' gestation were clustered with EDD, FS, RI in the umbilical artery and UPR. Three different groups were revealed. In cluster 1 (C1), larger fetuses showed a significant increase in both EDD and UPR, and a significant decrease in FS, while smaller fetuses had a significant increase in RI and a decrease in UPR. In cluster 2 (C2), smaller fetuses showed a significant increase in RI. Cluster 3 (C3) showed no significant deviations in any variable when referring to singleton pregnancies. C1 had a higher perinatal mortality rate than either C2 or C3, with the cause of death being cardiac failure in larger fetuses and renal failure in smaller fetuses. The frequencies of discordancy, hemoglobin difference above 5g/dl and monochorionic placenta in C1 were also higher than fetuses in C3. C2 also showed higher frequencies of discord
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ancy and small-for-gestational age than C3 fetuses. In C2 and C3, respiratory insufficiency was found to be the cause of neonatal death. The results revealed that C1 consists of twins with both larger and smaller fetuses displaying cardiac failure with an increase in renal perfusion and a decrease in renal and placental perfusion, respectively, and C2 consists of twin s with smaller fetuses having both placental insufficiency and intrauterine growth retardation. C3 consists of twins with both larger and smaller fetuses having normal circulation.
2) Qualitative analysis of blood velocity in the umbilical arteries and superficial placental vessels in 5 cases of twin pregnancy revealed abnormal patterns, permitting accurate antenatal diagnosis of artery-to-artery anastomoses, using color flow mapping and pulsed Doppler velocimetry. These 5 cases, of which 3 cases manifested clinical signs of twin-to-twin transfusion syndrome, had monochorionic-diamniotic placentas with superficial artery-to-artery anastomoses. These results indicate that periodic alterations of blood flow velocity waveforms are useful in detecting artery-to-artery anastomoses, a direct finding in monozygotic twins in utero. Less
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