Outcome of laser photocoagulation in monochorionic diamniotic twin pregnancy complicated by Type‐II selective fetal growth restriction

Abstract

ObjectiveTo evaluate the outcomes of monochorionic diamniotic (MCDA) twins complicated by selective fetal growth restriction (sFGR) Type II who underwent laser photocoagulation and to validate the subclassification previously proposed by Chmait et al. (Type IIA with normal Doppler assessment of the ductus venosus (DV) and middle cerebral artery (MCA) of the growth‐restricted fetuses and Type IIB with DV absent or reversed flow during atrial contractions and/or MCA peak systolic velocity equal or greater than 1.5 Multiple of Median [MoM]) in a larger multicenter cohort.MethodsThis retrospective multicenter study included all MCDA twins complicated by Type II sFGR who underwent laser photocoagulation of placental anastomoses at four large tertiary fetal care centers between 2006 and 2020. Cases were then subclassified into Type IIA or IIB based of Doppler evaluation of fetal DV and MCA‐PSV as previously mentioned. Demographic characteristics and pregnancy outcomes were compared between groups. Data was presented as mean ± standard deviation or numbers and percentages as appropriate. P‐value ˃0.05 is considered statistically significant.ResultsA total of 98 patients with MCDA twins met our inclusion criteria, with 56 sub‐classified as Type IIA and 42 as Type IIB. Demographic characteristics were similar between the groups; however, Type IIB cases tended to have an earlier gestational age at diagnosis and at laser surgery as well as larger intertwin estimated fetal weight discordance, which may be a reflection of disease severity. Postnatal survival of the growth‐restricted fetus was significantly lower in Type IIB compared to Type IIA cases (23.8% vs 46.4%, P = 0.034)ConclusionsIn MCDA twins complicated by sFGR Type II and treated with laser photocoagulation of placental anastomoses, preoperative Doppler assessment of the ductus venosus and middle cerebral artery help to identify subset of patients at increased risk of demise of the growth‐restricted fetuses following intervention. Our study provides valuable information for guiding the surgical management options and patient counseling.This article is protected by copyright. All rights reserved.