THE EVALUATION OF DISCORDANCE IN TWINS WITH SPECIFIC AND NON-SPECIFIC PATHOLOGY BY MEASUREMENTS OF LIVER, THYROID GLAND AND KIDNEYS

Abstract

Introduction: Discordant biometric indices in twins may be the markers of pathologic development. Prenatal ultrasound of some organs is important for establishing complete diagnosis. Objective is to propose the new approaches to the evaluation of well-being of twins with discordance. Materials and Methods: In fetuses with specific and non-specific complications of 58 monochorionic diamniotic (MCDA) twin pregnancies, the following investigations were performed: 2D/3D ultrasound, Doppler, and invasive procedures on indication. The following parameters in twins were analyzed: expected fetus weight, amount of amniotic fluid, measurements of liver, kidneys and thyroid gland. Results: The research showed that the maximum discordance of all studied parameters took place at feto-fetal transfusion syndrome (FFTS). The presence of significant discordance was noted for the expected fetus weight in 2nd and 3rd trimester (31.7%±2,9), amount of amniotic fluid (76.2%±3,36), size of the liver (27.5%±2,8) and thyroid gland (34.7%±2,35). Maximal discordance was seen in the amount of amniotic fluid which is a typical manifestation of pathology. In selective intrauterine growth retardation (SIUGR), there was significantly high discordance between fetuses in relation to the expected fetus weight (32.4%±3,36) and amount of amniotic fluid (38.8%±4,2), compared to the control group. The higher discordance of the amount of amniotic fluid is associated with oligohydramnion, which occurs in 33.3% of SIUGR. Since there was no polyhydramnion in the larger fetus, there was no discordance of the amount of amniotic fluid. Conclusions: The discordance of the expected fetus weight, the amount of amniotic fluid, the size of the liver, kidneys and thyroid gland in fetuses with specific and nonspecific complications of multiple pregnancy was evaluated. The discordance may be diagnosed not only with expected fetus weight, but also by measurement of only liver or thyroid gland.