Abstract
The aim of the study was to derive an objective definition of pulsatile umbilical venous flow (PUVF). Pulsed Doppler waveform analysis of the umbilical vein was performed in stages III and IV twin-twin transfusion syndrome (TTTS) patients. In patients with PUVF, the umbilical vein maximum (Vmax) and the umbilical vein minimum velocity (Vmin) and the resistance index for the umbilical vein (UVRI) = (100 x [Vmax - Vmin]/Vmax) were assessed. PUVF was noted in 130 of 226 stages III and IV TTTS patients. Digital images were available for analysis in 65 of 130 patients (50%). The minimum UVRI associated with PUVF was 16% for stages III and IV TTTS. There was a trend for increasing UVRI with stage (P = .052). Stage IV patients were more likely to have an UVRI greater than 30% (P = .02). PUVF can be defined as an UVRI greater than 15%. A scale definition of PUVF may further facilitate assessment of the degree of fetal hemodynamic compromise.
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