Non-invasive method of evaluation of trophoblast invasion of spiral arteries in monochorionic twins with discordant birthweight.

ABSTRACT

To test the hypothesis that variation in birthweight between twin pairs is due to discordant placental development, we determined spiral arterial blood flow by colour pulsed Doppler ultrasound scan. We prospectively studied 24 twin pregnancies in the late second trimester with (n=12) and without (n=12) inter-pair difference in estimated birthweight of > or = 20 per cent. In the discordant growth group, there were seven cases with chronic twin-twin transfusion syndrome (TTTS) and five without. The blood flow in spiral artery of each twin's portion of the placenta was assessed by resistance index (RI) by colour flow pulsed Doppler within a 5 cm radius of cord insertion. In twins with discordant weight, RI was increased in the growth restricted (FGR) twin than the appropriate for gestational age (AGA) co-twin (0.46 +/- 0.02 vs 0.3 +/- 0.01; P< 0.001) and the control group (P< 0.001). However, delta RI was comparable between twins with and without TTTS (0.13 +/- 0.01 vs 0.19 +/- 0.02; P=NS). No such differences were found between concordant twin pairs (0.28 +/- 0.01 vs 0.29 +/- 0.1; P=NS) and AGA twins of the discordant growth group. This study indicates that growth restricted twins have increased resistance to blood flow in the spiral arteries than the AGA co-twins. This observation, therefore, suggests non-physiological remodelling of the maternal spiral arteries in response to migrating trophoblast in placental bed of FGR MC twins.