Hepatic arterial buffer response in monochorionic twins with selective fetal growth restriction

Jader de Jesus Cruz; Joana Bernardeco; Claudia Rijo; Alvaro Cohen; Fatima Serrano

doi:10.1515/jpm-2024-0016

Article

Hepatic arterial buffer response in monochorionic twins with selective fetal growth restriction

Jader de Jesus Cruz , Joana Bernardeco , Claudia Rijo , Alvaro Cohen and Fatima Serrano

Published/Copyright: May 21, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 6

Abstract

Objectives

Monochorionic twins (MC) have higher risk of perinatal morbi-mortality compared to singletons and dichorionic twins (DC). Selective fetal growth restriction (sFGR) increases the chances of adverse outcome. Hepatic arterial buffer response (HABR) is an important mechanism for maintaining liver perfusion. We hypothesised that HABR is active in monochorionic diamniotic twins (MCDA) with sFGR where restricted fetus may have liver hypoperfusion. The objective of this study is to test whether the HAV-ratio is diminished in pregnancies affected by selective fetal growth restriction pointing to activation of HABR in the growth-restricted fetus.

Methods

sFGR was defined according to a consensus definition. Hepatic artery (HA) peak systolic velocity (PSV) was measured and its correlation with fetal Dopplers and pregnancy characteristics were determined. A ratio using HA-PSV (HAV-ratio) was calculated and its association with sFGR was established. Further analysis of HA-PSV was performed comparing z-scores between normal and growth restricted fetuses.

Results

We included 202 MCDA pregnancies, 160 (79 %) normal and 42 (21 %) with sFGR. HAV-ratio was significant different between groups. The mean HAV-ratio was 1.01 (±0.20) for normal twins and 0.77 (±0.25) for sFGR. Furthermore, HA-PSV z-scores was significant increased in in growth-restricted fetus (0.94±1.45), while in normal fetuses was −0.16 (±0.97).

Conclusions

Our findings demonstrate that, in pregnancies with sFGR, HAV-ratio is significantly lower than in normal MCDA pregnancies. The lower HAV-ratio is due to an increase in HA PSV in the growth restricted fetus. This observation indicates an activation of HABR in the small fetus.

Keywords: monochorionic twin pregnancy; selective fetal growth restriction; fetal liver hemodynamic; hepatic artery; fetal Doppler; hepatic arterial buffer response

Corresponding author: Jader de Jesus Cruz, MD, MSc, Department of Fetal Medicine, Central Lisbon University Hospitals, R. Viriato 1, 2890-495 Lisbon, Portugal, E-mail: jaderjcruz@icloud.com

Research ethics: The research had complied with all relevant regulations, institutional policies, and has been approved by two Ethics Committees for Research under the numbers NMS / FCM-UNL no. 08/2021/CEFCM and CHULC no. 1008/2021.
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Data are available from the authors upon reasonable request and with permission from the ethic committee.

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Received: 2024-01-14

Accepted: 2024-04-27

Published Online: 2024-05-21

Published in Print: 2024-07-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2024-0016

Keywords for this article

monochorionic twin pregnancy; selective fetal growth restriction; fetal liver hemodynamic; hepatic artery; fetal Doppler; hepatic arterial buffer response