{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T04:23:44Z","timestamp":1775795024475,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the association between elevated (&gt;\u20091.5 multiples of the median (MoM)) middle cerebral artery (MCA) peak systolic velocity (PSV) and fetal demise of the donor twin in pregnancies complicated by twin\u2013twin transfusion syndrome (TTTS) in the absence of twin anemia\u2013polycythemia sequence (TAPS). Secondary objectives were to evaluate if donor or recipient MCA\u2010PSV is associated with a risk for their corresponding fetal death, and to compare the proportion of donor fetuses with low MCA pulsatility index (PI) among donor twins with high MCA\u2010PSV and those with normal MCA\u2010PSV to evaluate the contribution of blood\u2010flow redistribution to the fetal brain in donor twins with high MCA\u2010PSV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. Multivariable and Poisson regression analysis were performed to explore the association between isolated elevated donor MCA\u2010PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR) and other confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 660 TTTS cases, donor MCA\u2010PSV was not recorded in 48 (7.3%) cases. Of the remaining 612 patients, nine (1.5%) were lost to follow\u2010up and 96 TAPS cases were excluded; thus, 507 cases were included in the study. High donor MCA\u2010PSV was seen in 6.5% (33\/507) of cases and was an independent risk factor for donor fetal demise (adjusted relative risk (aRR), 4.52 (95%\u2009CI, 2.72\u20137.50)), after adjusting for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA\u2010PSV was an independent risk factor for fetal demise of the donor in Quintero Stage II (aRR, 14.21 (95%\u2009CI, 1.09\u2013186.2)) and Quintero Stage III (aRR, 3.41 (95%\u2009CI, 1.82\u20136.41)). Donor MCA\u2010PSV in MoM was associated with fetal demise of the donor (area under the receiver\u2010operating\u2010characteristics curve (AUC), 0.69;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), but recipient MCA\u2010PSV in MoM was not associated with fetal demise of the recipient (AUC, 0.54;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.44). A higher proportion of donor twins in the group with high MCA\u2010PSV had a low MCA\u2010PI compared to the group with normal MCA\u2010PSV (33.3%\n                      <jats:italic>vs<\/jats:italic>\n                      15.5%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated donor MCA\u2010PSV without TAPS prior to laser surgery for TTTS is associated with a 4\u2010fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage and other confounders. Doppler evaluation of donor MCA\u2010PSV prior to laser surgery may help stratify TTTS staging to evaluate the risk of donor fetal demise. \u00a9 2024 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.27629","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T13:53:52Z","timestamp":1709560432000},"page":"222-227","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Elevated middle cerebral artery peak systolic velocity and risk of death in donor twin affected by twin\u2013twin transfusion syndrome but not twin anemia\u2013polycythemia sequence"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9830-2212","authenticated-orcid":false,"given":"J.","family":"Espinoza","sequence":"first","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Hernandez\u2010Andrade","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0963-1584","authenticated-orcid":false,"given":"S.","family":"Backley","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3801-346X","authenticated-orcid":false,"given":"R.","family":"Papanna","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6276-854X","authenticated-orcid":false,"given":"E. P.","family":"Bergh","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,6,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13351"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7488"},{"issue":"393","key":"e_1_2_8_5_1","first-page":"e1","article-title":"Stage\u2010based outcomes of 682 consecutive cases of twin\u2010twin transfusion syndrome treated with laser surgery: the USFetus experience","volume":"204","author":"Chmait RH","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000225945.17022.6b"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7713"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000304512"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20096"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23585"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061759"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000858"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13206"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050701591827"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.01.010"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6436"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100561"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0226090"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.181.1.1887021"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.6288"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5948"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000505780"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26252"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2006.01.010"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.08.069"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.18"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15838"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2453"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.27629","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.27629","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.27629","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T02:58:44Z","timestamp":1775789924000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.27629"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,22]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1002\/uog.27629"],"URL":"https:\/\/doi.org\/10.1002\/uog.27629","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,22]]},"assertion":[{"value":"2023-12-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}