{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:19:04Z","timestamp":1778152744046,"version":"3.51.4"},"reference-count":31,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,3,31]],"date-time":"2020-03-31T00:00:00Z","timestamp":1585612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate infant survival according to the Doppler pattern of impedance to blood flow in the umbilical arteries (UAs) prior to laser surgery, in pregnancies with twin\u2010to\u2010twin transfusion syndrome (TTTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study of women with a monochorionic diamniotic twin pregnancy who underwent laser surgery for TTTS between January 2012 and May 2018 at a single institution. Absolute intertwin difference in UA pulsatility index (DUAPI) was measured within 48\u2009h prior to laser surgery. Twins with intermittent or persistent absent\/reversed end\u2010diastolic flow (EDF) in the UA (UA\u2010EDF) were analyzed separately. Survival of both or at least one infant at birth and at 30\u2009days postpartum was compared between pregnancies with an intertwin DUAPI of \u2265\u20090.4 and those with an intertwin DUAPI of &lt;\u20090.4, as well as between fetuses with intermittent and those with persistent absent\/reversed UA\u2010EDF. Parametric and non\u2010parametric tests were used for analysis. Regression analysis was performed to determine if intertwin DUAPI and intermittent or persistent absent\/reversed UA\u2010EDF were associated independently with infant survival, while controlling for gestational age at delivery, Quintero stage and other important confounding variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 231 TTTS pregnancies that underwent laser surgery during the study period, UA Doppler information could be retrieved for 206 and delivery information was available for 184, which comprised the study population. Rates of double\u2010twin survival at birth were significantly higher in pregnancies with an intertwin DUAPI of &lt;\u20090.4 than in those with an intertwin DUAPI of \u2265\u20090.4 (83.9% (78\/93) <jats:italic>vs<\/jats:italic> 50.0% (12\/24); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Double\u2010infant survival at birth was higher in pregnancies with intermittent compared to those with persistent absent\/reversed UA\u2010EDF (73.0% (27\/37) <jats:italic>vs<\/jats:italic> 36.7% (11\/30); <jats:italic>P<\/jats:italic>\u2009=\u20090.003). Regression analysis demonstrated that an intertwin DUAPI of &lt;\u20090.4 was associated with increased survival of both twins at delivery (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and at 30\u2009days postpartum (<jats:italic>P<\/jats:italic>\u2009=\u20090.002), as well as increased survival of at least one twin at delivery (<jats:italic>P<\/jats:italic>\u2009=\u20090.009). Similarly, intermittent absent\/reversed UA\u2010EDF was associated with increased survival of both twins at delivery (<jats:italic>P<\/jats:italic>\u2009=\u20090.007) and at 30\u2009days after birth (<jats:italic>P<\/jats:italic>\u2009=\u20090.015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Evaluation of intertwin differences in UA impedance to blood flow as well as identification\nof intermittent or persistent absent or reversed UA\u2010EDF prior to laser surgery could help in the prediction of double\u2010infant survival at birth and to 30\u2009days in twin pregnancies with TTTS. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.20298","type":"journal-article","created":{"date-parts":[[2019,4,22]],"date-time":"2019-04-22T08:15:26Z","timestamp":1555920926000},"page":"489-495","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between impedance to blood flow in umbilical arteries and infant survival in twin\u2010to\u2010twin transfusion syndrome"],"prefix":"10.1002","volume":"55","author":[{"given":"A. F.","family":"Espinoza","sequence":"first","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7887-5737","authenticated-orcid":false,"given":"M. A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. A.","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. M.","family":"Hudson","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"X.","family":"Parisi","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-7965","authenticated-orcid":false,"given":"A. A.","family":"Nassr","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Sanz Cortes","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Erfani","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9830-2212","authenticated-orcid":false,"given":"J.","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,3,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.04.022"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2193"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.19"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000723"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2010.09.003"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13351"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7488"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.02.001"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000225945.17022.6b"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7713"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.02.024"},{"key":"e_1_2_6_14_1","first-page":"1058","article-title":"Antenatal diagnosis of twin\u2013twin transfusion syndrome by Doppler ultrasound","volume":"78","author":"Yamada A","year":"1991","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02390673"},{"key":"e_1_2_6_16_1","first-page":"1097","article-title":"Doppler umbilical artery studies in the twin\u2013twin transfusion syndrome","volume":"76","author":"Giles WB","year":"1990","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15821"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17520"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15147"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2010.02.018"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.01.015"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.865"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2013.04.005"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2009.12.024"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15822"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1013"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0143-4004(03)00114-0"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(94)90308-5"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1999.tb08256.x"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.175"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15745"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.01.051"}],"container-title":["Ultrasound in Obstetrics &amp; 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