Clinical outcome and placental territory ratio of monochorionic twin pregnancies and selective intrauterine growth restriction with different types of umbilical artery Doppler

Chang, Yao‐Lung; Chang, Shuenn‐Dyh; Chao, An‐Shine; Hsieh, Peter C.C.; Wang, Chao‐Nin; Wang, Tzu‐Hao

doi:10.1002/pd.2193

Cited by 87 publications

(72 citation statements)

References 17 publications

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“…As revealed in our previous studies, MC pregnancies with sIUGR and UA-AEDF saw more severe placenta share discordance than those where the sIUGR twin showed normal UA Doppler (Chang et al, 2009). So, the etiology of UA-AEDF in sIUGR twin could be partly attributed to severe placenta share discordance (Chang et al, 2009).…”

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confidence: 54%

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Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Chang

Chao

et al. 2012

Twin Res Hum Genet

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This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin-estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.

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confidence: 54%

“…So, the etiology of UA-AEDF in sIUGR twin could be partly attributed to severe placenta share discordance (Chang et al, 2009). However, would a similar relationship also exist between the betamethasone-induced return of positive UA end-diastolic flow and the placental share discordance in MC pregnancy with sIUGR and UA-AEDF?…”

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confidence: 99%

Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Chang

Chao

et al. 2012

Twin Res Hum Genet

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“…Los gemelos monocoriónicos tienen un riesgo elevado de anomalías congénitas, STEG, restricción de crecimiento-RCIU selectivo y muerte fetal intrauterina (11,43) . Su prevalencia es superior al 50% (44) .…”

Section: Muerte Fetal Intrauterina Por Corionicidadunclassified

Muerte fetal intrauterina de uno de los gemelos

Rondón-Tapia

2018

Rev peru ginecol obstet.

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RESUMENLos embarazos múltiples, la mayoría de los cuales son gemelares, tienen un riesgo sustancialmente mayor de morbimortalidad fetal comparado con los embarazos únicos. La muerte fetal de uno de los gemelos en embarazos gemelares monocoriónicos es más frecuente que en embarazos gemelares dicoriónicos. La muerte fetal intrauterina ocurre en 1 a 7% de todos los embarazos gemelares y aumenta considerablemente la tasa de complicaciones del gemelo superviviente, incluyendo pérdida fetal, parto prematuro y daño de órgano final. La edad gestacional en que ocurre la muerte fetal intrauterina y la corionicidad de los embarazos múltiples son los dos factores más importantes al considerar los riesgos del gemelo superviviente. La morbimortalidad de estos embarazos puede disminuir con la identificación del embarazo de riesgo y la vigilancia prenatal intensiva. Los embarazos monocoriónicos son más difíciles de manejar y a menudo los embarazos se interrumpen entre las 34 y 36 semanas. Los embarazos dicoriónicos se pueden interrumpir más cerca del término. Palabras clave. Muerte intrauterina de un gemelo, Muerte fetal intrauterina, Embarazo gemelar. ABSTRACTMultiple pregnancies, most of which are twins, have a substantially increased risk of fetal morbidity and mortality compared to single pregnancies. The fetal death of one of the twins in monochorionic twin pregnancies is more frequent than in twin dichorionic pregnancies. Intrauterine fetal death occurs in 1-7% of all twin pregnancies and greatly increases the rate of complications of the surviving twin including fetal loss, preterm birth, and end organ damage. The gestational age at which intrauterine fetal death occurs and the chorionicity of the multiple pregnancy are the two most important factors when considering the risks of the surviving twin. The morbidity and mortality of these pregnancies may decrease with risk identification and intensive prenatal surveillance. Monochorionic pregnancies are more difficult to manage, and often pregnancies are interrupted at 34-36 weeks. Dichorionic pregnancies can be interrupted closer to term.

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“…La relación entre el territorio de la placenta desigual y discordancia de peso al nacer se ha puesto de manifiesto en varios estudios 13,14,15 demostrando que la misma aumenta con el incremento de discordancia del territorio placentario. Recientemente Van Winden et al 26 examinaron los pesos placentarios en fresco de 91 placentas de gestaciones MC/BA con diagnóstico de STFF y RCIUs y los compararon con 64 gestaciones con diagnósticos de STFF solamente, todas fueron sometidas a cirugía láser.…”

Section: Etiopatogeniaunclassified

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Cosp

2016

Rev. Nac. (Itauguá)

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RESUMENLa Restricción Selectiva del Crecimiento Intrauterino se produce en 10 a 19% de los gemelos monocoriónicos y se asocia con un aumento importante de la mortalidad y la morbilidad perinatal. La evolución clínica está dada en gran parte por la presencia de anastomosis vaculares y la distribución placentaria asimétrica. Se propuso una clasificación en tres tipos según el Doppler de la arteria umbilical del gemelo más pequeño, la que sé que se correlaciona con distintos comportamientos clínicos y características de la placenta, lo que ayuda en el asesoramiento y conducta obstétrica. Los del tipo I tienen un pronóstico favorable por el resultado perinatal satisfactorio por lo que se recomienda un seguimiento cercano por ecografía y Doppler. Los de tipo II tienen un mal pronóstico y el tipo III un pronóstico intermedio e impredecible. En estos dos últimos se puede realizar un manejo expectante hasta que se observe deterioro del feto pequeño, considerando la posibilidad de la coagulación con láser o la oclusión del cordón (feticidio selectivo). Ambas conductas aparentemente aumentan las posibilidades de supervivencia del feto de peso normal.Palabras claves: restricción selectiva del crecimiento intrauterino, diagnóstico, manejo, gemelos monocoriales, doppler, terapia fetal ABSTRACT Selective intrauterine growth restriction occurs in 10-19% of monochorionic twins and is associated with increased mortality important and perinatal morbidity. The clinical course is given largely by the presence of placental vascular anastomosis and asymmetric distribution. It classified into three types according to the proposed Doppler umbilical artery smaller twin, the one that correlates with different clinical behaviors and characteristics of the placenta, which helps in counseling and obstetric conduct. The type I have a favorable prognosis for satisfactory perinatal outcome so closely monitored by ultrasound and Doppler is recommended. The type II has a poor prognosis and type III intermediate and unpredictable prognosis. In these last two you can make an expectant management until deterioration of the small fetus is observed, considering laser coagulation or cord occlusion(selective feticide). Both behaviors appear to increase the chances of survival of the fetus of normal weight.

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Clinical outcome and placental territory ratio of monochorionic twin pregnancies and selective intrauterine growth restriction with different types of umbilical artery Doppler

Abstract: In MCDA twins with sIUGR, abnormal UA Doppler in the IUGR twin may reflect a more severe unequal placenta share and poorer neonatal outcomes. The prognosis of group II MCDA twins, even with sIUGR found in early gestation, is, by contrast, better.

Cited by 87 publications

References 17 publications

Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link?

Muerte fetal intrauterina de uno de los gemelos

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

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