Intrauterine growth restriction in monochorionic-diamniotic twins

Abstract

IntrauterIne growth restrIctIon In monochorIonIc-dIamnIotIc twIns rev assoc med Bras 2014; 60(6):585-590 585Original articleIntrauterine growth restriction in monochorionic-diamniotic twins Conflict of interest: noneObjective: to evaluate neonatal morbidity and mortality in monochorionic--diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10 th percentile on twins' growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16).Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR.

Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta‐analysis

“…There were eight studies (332 twins) on expectant management in Type‐I sFGR, one study (six fetuses) reporting the outcome of pregnancies complicated by Type‐I sFGR treated with laser therapy of placental anastomoses, and two studies (six twins) reporting the outcome of Type‐I sFGR treated with SR of the smaller twin (Table , Figure a).…”

Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction

“…MEDLINE, EMBASE, CINAHL, http://clinicaltrials.gov and The Cochrane Library databases were searched electronically using a comprehensive search strategy (Appendix S1). Thirty‐nine studies were included in the analysis, comprising 21 retrospective and 13 prospective cohort studies, three non‐comparative studies, one case–control and one cross‐sectional study (Table ). Fetal, neonatal and perinatal mortality were reported commonly across the included studies.…”

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

“…Profundas: VA veno-arteriales, AV arterio-venosas. Nótese que las comunicaciones AA y VVtienen un punto de choque en la superficie de la placenta en tanto que las comunicaciones AV y VA son profundasy unidireccionales (Tomado de Velazco Herrero M et al) 10 Las comunicaciones VV y AA son bidireccionales, se presentan en la superficie de la placenta, por lo que se les denomina superficiales y en ellas ambas circulaciones chocan en sentidos opuestos. Las comunicaciones AV/ VA son unidireccionales, una arteria de un gemelo irriga un cotiledón común de donde sale una vena que llega al otro feto.…”

“…La prevalencia de RCIUs basado en el peso fetal por debajo del percentil 10 se estima entre el 10 a 15% 10,11 , en tanto que utilizando la discordancia de más del 25% entre los fetos, entre 11,3 a 19% de las gestaciones monocoriales 12,13 .…”

“…La detección de la lesión cerebral temprana después del nacimiento (dentro de 1-2 semanas) sugiere una etiología prenatal, mientras que la detección tardía (≥2 semanas después del parto) sugiere una etiología postnatal. Machado et al 74 analizaron en una cohorte retrospectiva de 34 gestaciones gemelares MC/BA, 16 con RCIUs y 18 con restricción del crecimiento intrauterino de ambos gemelos (RCIUns), la mortalidad y morbilidad neonatal en ambos grupos. Reportaron que el grupo de RCIUs tenían una mayor frecuencia de intubación endotraqueal (p=0,001), asistencia con ventilaciónmecánica (p = 0,0006) y un mayor tiempo de ayuno durante la hospitalización (p = 0,014), en comparación con los gemelos RCIUns.…”