P07.01: Myocardial performance index (MPI) as a warning sign of fetal demise in an MCDA twin pregnancy?

Abstract

A 41 year old G1P0 with spontaneous MCDA twins was enrolled in a research cohort of initially uncomplicated MCDA twin pregnancies (MPI waveforms acquired and stored for later analysis). Ultrasounds at 20–26 weeks showed concordant 10th–20th centile growth with normal amniotic fluid, umbilical artery, middle cerebral artery (MCA) and ductus venosus Doppler studies in both babies. At 28 weeks and 6 days growth and fluid remained concordant, however as Twin 1's MCA-PSV measured 1.3 MoM and Twin 2's 0.7 MoM referral for second opinion/rule out TAPS was made. At this visit at 29+1 MCA-PSVs were normal in both babies (0.9MoM and 1.0MoM), babies were moving well and it was felt there was no evidence of pathology. However at follow-up at 30+1 weeks there was single IUFD of Twin 2, whose MPI values (on later analysis for the research cohort) were noted to be increasingly abnormal (table 1). There was no ultrasonic evidence of anemia in the surviving twin, who was ultimately born at 34 weeks gestation after spontaneous preterm labour (1870 g, Hb144 g/L, no major neonatal complications) with normal neonatal intracranial ultrasound and no abnormalities at 6 month follow-up. Impression: In retrospect, fetal cardiac function measured by MPI, in particular Delta MPI and Intertwin Difference, became increasingly abnormal in Twin 2 prior to demise, while routine biometry, AFI and Dopplers did not clearly show significant pathology. Ongoing investigation of potential utility of MPI in MCDA twin surveillance is warranted.