Fetus-Placenta-NewbornNatriuretic peptides in the pathogenesis of cardiac dysfunction in the recipient fetus of twin-twin transfusion syndrome☆
Section snippets
Patients
This observational study of 14 consecutive cases of monochorionic twins with TTTS and 6 without TTTS, was conducted in a tertiary referral center. Monochorionicity was established ultrasonically by (a) concordant genitalia, (b) interfetal membrane thickness of <2.0 mm, and (c) single placental mass, and was confirmed by use of placental histology after birth. Only those cases in which both fetuses were alive at the time of fetal blood sampling (FBS) were included in this study. The inclusion
Results
Clinical features of the two groups are shown in the Table.Parameter TTTS (n = 14) Non-TTTS (n = 6) P value Gestational age at diagnosis (wk) 21 (16-28) Gestational age at FBS (wk) 23 (19-30) 30 (21-34) NS Gestational age at delivery (wk) 27 (21-36) 31 (24-36) NS Maximum AFL (cm) 58 (35-79) 16 (12-24) <.001 No. of amnioreductions 2 (1-8) Total amniotic fluid volume removed (L) 0.7 (.3-20) Δ Hemoglobin at FBS (g/dL) 3
Comment
This study demonstrates elevated levels of natriuretic peptides ANP and BNP in utero in recipient fetuses of TTTS of midtrimester origin. However, we also found that fetal BNP levels were significantly higher in the recipient fetuses with severe cardiac dysfunction than in those with normal function. In contrast, fetal ANP did not show such an association. Our findings are in keeping with the growing recognition in the human adult subjects that plasma BNP is a sensitive marker in physiologic
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Cited by (78)
Congenital heart disease in monozygotic twins
2020, Developmental and Fetal Origins of Differences in Monozygotic Twins: From Genetics to Environmental FactorsCardiomegaly of the larger twin in monochorionic twin pregnancies warrants neonatal intensive care even without twin-to-twin transfusion syndrome
2019, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Cardiac enlargement is not considered rare among TTTS cases and should be noted even in non-TTTS cases. Increased fetal blood and amniotic fluid levels of BNP are reportedly related to recipient cardiac dysfunction in TTTS [12,27]. Several larger twins in this study did not have TTTS, but were considered to have hemodynamics similar to recipients of TTTS.
Recipient umbilical artery elongation (redundancy) in twin-twin transfusion syndrome
2017, American Journal of Obstetrics and GynecologyCitation Excerpt :Myocardial strain and tissue velocities provide a direct reflection of myocardial performance, while the Tei index (which compares the length of time the heart spends in generating relaxation and contraction vs its active state) and cardiac output reflect more global function.5-7 Elevated inactive component N-terminal (NT) pro-brain natriuretic peptide (BNP) levels have been measured in the amniotic fluid (AF), in recipient fetuses with heart failure, or severe disease.8-10 However, the effect of fetal intravascular overload and hypertension on the fetal vascular architecture and its correlation with disease severity remains unknown.
Cardiovascular biomarkers in paired maternal and umbilical cord blood samples at term and near term delivery
2016, Early Human DevelopmentCitation Excerpt :Possibly the fetus has to increase his diuresis by natriuretic peptide elevation in order to maintain an adequate amount of amniotic fluid and to handle maternofetal fluid transfer over the placenta. In discordant twin pregnancies with placental feto-fetal anastomoses could be shown that the acceptor has higher natriuretic peptide levels than the donor, analogous to the distribution of amniotic fluid between donor and acceptor [9]. These literature data support the physiological relevance of natriuretic peptides during fetal development.
Consensus protocol for management of early and late twin–twin transfusion syndrome: Delphi study
2024, Ultrasound in Obstetrics and GynecologyTwin-Twin Transfusion Syndrome: Complications and Management
2023, Practical Guide to Simulation in Delivery Room Emergencies
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Reprint requests: Rekha Bajoria, St Mary's Hospital, Whitworth Park, Manchester M13 OJH, UK. E-mail: [email protected].