Cases of monochorionic / diamniotic twin pregnancies diagnosed with twin-twin transfusion syndrome.

Controls of monochorionic / diamniotic twin pregnancies without a diagnosis of twin-twin transfusion syndrome.

Twin Twin Transfusion Syndrome

Doppler ultrasound assessment of the proximal fetal renal artery to with measurement of the peak systolic velocity, resistive index, pulsatility index, and systolic/diastolic ratio.

Doppler ultrasound of fetal renal artery

Columbia University Medical Center

Renal Artery Dopplers in Twin Twin Transfusion Syndrome

Are Renal Artery Doppler Indices Different Between Monochorionic Diamniotic Twins With Twin-twin Transfusion Syndrome and Monochorionic Diamniotic Twins Without Twin-twin Transfusion Syndrome?

Doppler ultrasound assessment of the proximal fetal renal artery with measurement of the peak systolic velocity for twin A.

Doppler ultrasound assessment of the proximal fetal renal artery with measurement of the resistive index for twin A.

Doppler ultrasound assessment of the proximal fetal renal artery with measurement of the pulsatility index for twin A.

Doppler ultrasound assessment of the proximal fetal renal artery with measurement of the peak systolic velocity for twin B.

Doppler ultrasound assessment of the proximal fetal renal artery with measurement of the resistive index for twin B.

Doppler ultrasound assessment of the proximal fetal renal artery with measurement of the pulsatility index for twin B.

There is no plan to share individual participant data with other researchers.

Russell Miller

Assistant Professor of Obstetrics and Gynecology

Columbia University

Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs

Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
o 1 hour +/- 30 minutes after submersion therapy
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
o 1 hour +/- 30 minutes after submersion therapy
AFI (Baseline, day 3, 7 {or Discharge}) o 1 hour +/- 30 minutes after submersion therapy
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs
HYDROTHERAPY TWICE DAILY FOR 3-7 DAYS o Blood pressure, pulse, pulse pressure, body weight, and fetal heart rate before and after submersion therapy

IV/Oral Hydration and Bedrest:
Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs

IV/Oral Hydration and Bedrest

• HYDROTHERAPY TWICE DAILY FOR 3-7 DAYS
o Blood pressure, pulse, pulse pressure, body weight, and fetal heart rate before and after submersion therapy
Hydrotherapy:
Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
o 1 hour +/- 30 minutes after submersion therapy
AFI (Baseline, day 3, 7 {or Discharge}) o 1 hour +/- 30 minutes after submersion therapy
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs

Hydrotherapy Group

Total

Sex: Female, Male

Ethnicity (NIH/OMB)

Race (NIH/OMB)

Region of Enrollment

Subjects amniotic fluid index via ultrasound on days 3, 5 and 7 of study participation.

IV/Oral Hydration and Bedrest for up to 7 days
US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs
: • Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV

HYDROTHERAPY TWICE DAILY FOR 3-7 DAYS
Maternal BP (sitting) US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
o 1 hour +/- 30 minutes after submersion therapy
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
o 1 hour +/- 30 minutes after submersion therapy
AFI (Baseline, day 3, 7 {or Discharge}) o 1 hour +/- 30 minutes after submersion therapy
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs
Blood pressure, pulse, pulse pressure, body weight, and fetal heart rate before and after submersion therapy
Hydrotherapy: • Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight

1. Primary: Number of Participants With Reversal of Oligohydramnios Using AFV Measures

Secondary:
- Changes in maternal hemodynamic status by mobilizing extravascular fluid

IV/Oral Hydration and Bedrest up to 7 days
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs
: • Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital sign

• HYDROTHERAPY TWICE DAILY FOR 3-7 DAYS
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs
Blood pressure, pulse, pulse pressure, body weight, and fetal heart rate before and after submersion therapy
Hydrotherapy: • Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge}) o 1 hour +/- 30 minutes after submer

Metabolic Status

1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation Strict I/O's Vital signs US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})

US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline,
Uterine Artery Doppler Flow (Baseline,
AFI (Baseline,
Strict I/O's
Vital signs
HYDROTHERAPY TWICE DAILY FOR 3-7 DAYS
o Blood pressure, pulse, pulse pressure, body weight, and fetal heart rate before and after submersion therapy Hydrotherapy: • Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow
Uterine Artery Doppler Flow • AFI (Baseline, day 3, 7 {or Discharge})

Overall Study

Ana Braescu

Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})
ALL ITEMS ABOVE MUST BE COMPLETED BEFORE:
1 Liter Water PO over 2 hours
1 Liter IV Fluid Bolus (NS) then titrated to 75 ml\hr for duration of the study participation
Strict I/O's
Vital signs
IV/Oral Hydration and Bedrest: • Maternal BP (sitting)
Pulse Pressure
Pulse
Urine Specific Gravity BID
Fetal Heart Rate
Maternal Body Weight US Procedures
AC/EFW
Umbilical Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
Uterine Artery Doppler Flow (Baseline, day 3, 7 {or Discharge})
AFI (Baseline, day 3, 7 {or Discharge})

oligohydramnios/hypoxia

Renal Artery Dopplers in Twin Twin Transfusion Syndrome

Hydrotherapy for the Reversal of Oligohydramnios

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