6 Doppler ultrasound in multiple pregnancies

This chapter aims to provide a current review of the use of Doppler ultrasound in the management of multiple pregnancies. OVID and Medline searches were undertaken. Randomized controlled trials, where available, were assessed by the Cochrane Review Manager (RevMan-version 3.0). The specific multiple pregnancy problems of fetal growth restriction (FGR), twin reversed arterial perfusion sequence and twin-twin transfusion syndrome (TTTS) were also reviewed. Historically, controlled and randomized controlled trials show a promising reduction in perinatal mortality in twin pregnancies where Doppler ultrasound is used. However, the numbers are small and further trials are recommended. In those twin pregnancies in which there is FGR as a result of placental dysfunction, Doppler ultrasonography will show intertwin discordancy. In those twin pairs where development is complicated by TTTS, there is often discordant fetal size, with concordant fetal Doppler results. Thus Doppler ultrasound appears to be useful in the management of twin pregnancies and in delineating those complicated by FGR and TTTS.