Outcome of monochorionic twin pregnancy complicated by <scp>Type‐III</scp> selective intrauterine growth restriction

Shinar, Shiri; Xing, Wen; Pruthi, Vagisha; Jianping, C.; Slaghekke, Femke; Groene, Sophie G.; Lopriore, Enrico; Lewi, Liesbeth; Couck, Isabel; Yinon, Yoav; Batsry, Linoy; Raio, Luigi; Amylidi-Mohr, Sofia; Baud, David; Kneuss, F.; DeKoninck, Philip; Moscou, J; Barrett, Jon; Melamed, Nir; Ryan, Greg; Sun, Luming; Mieghem, Tim Van

doi:10.1002/uog.23515

Cited by 21 publications

(29 citation statements)

References 25 publications

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“…Several previous studies addressed the outcomes of sFGR pregnancies and reported a more favorable outcome in Type III compared to Type II sFGR [1-3, 7]. This information is relevant in counseling parents.…”

Section: Discussionmentioning

confidence: 93%

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How to Better Distinguish between Type II and III Selective Fetal Growth Restriction in Monochorionic Twin Pregnancies?

2022

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OBJECTIVES: To determine additional variables, next to umbilical artery (UA) Doppler, to help differentiate between Type II and III selective fetal growth restriction (sFGR). METHODS: Retrospective analysis categorizing monochorionic diamniotic twin pregnancies with sFGR and abnormal UA Doppler as either Type II or III sFGR based on the diameter of the artery-to-artery (AA) anastomosis of ≤ 2 mm or > 2 mm, respectively on placental examination after birth. This exploratory study compared maternal characteristics, pregnancy outcome, placental characteristics, and ultrasound features between the two groups. RESULTS: We included 40 sFGR placentas, 13 were classified as Type II and 27 as Type III. Maternal age was higher in Type II. Small Type II twins had lower birth weights for gestational age and birth weight discordance was higher in Type II. Type III placentas were more unevenly divided, but Type III pairs differed less in birth weight than expected relative to their placental discordance. Type III placentas more commonly had a vein-to-vein anastomosis and larger artery-to-vein anastomoses than Type II placentas, and proximate cord insertions were only observed in Type III. On the ultrasound scan at first diagnosis, small Type II twins were more growth-restricted. An AA anastomosis was detected in half of the Type III cases and in none of the Type II group. Signs of high-output cardiac strain were observed only in large Type III twins. In contrast, placental dichotomy was detected in nearly half of the Type II cases and only one Type III case. CONCLUSIONS: The presence of an AA anastomosis, signs of cardiac strain in the large twin, and proximate cord insertions suggested Type III sFGR, whereas placental dichotomy and a severe growth restriction were typically present in Type II. Prospective studies need to validate if these markers help prenatal differentiation between Type II and III sFGR.

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Section: Discussionmentioning

confidence: 93%

“…This elaborate intertwin blood exchange compensates for the unequal sharing [5] but makes the twins interdependent. Although survival rates range from 78% to 87% [1, 3, 6, 7], fetal demise, usually of both twins, can occur suddenly due to an acute intertwin transfusion [2].…”

Section: Introductionmentioning

confidence: 99%

How to Better Distinguish between Type II and III Selective Fetal Growth Restriction in Monochorionic Twin Pregnancies?

2022

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“…For Type-III sFGR, on the other hand, fetal deaths are considered to be unpredictable, as Doppler surveillance is severely hampered by the fluctuating pattern caused by the large placental artery-to-artery anastomosis. Nevertheless, experts use non-evidence-based parameters such as oligohydramnios, abnormal ductus venosus flow or severe growth discordance to decide on earlier delivery or selective fetal reduction in Type-III sFGR 10,17 . Our findings support the unpredictability of fetal death in Type-III sFGR in many cases but also show that some factors can be used to quantify the risk of fetal mortality.…”

Section: Discussionmentioning

confidence: 99%

“…All pregnancies underwent EFW measurement on ultrasound, amniotic fluid assessment and fetal Doppler evaluation at least once every 2 weeks. The baseline characteristics, fetal growth pattern, management protocol and outcome of these pregnancies have been published previously 10,12 .…”

Section: Methodsmentioning

confidence: 99%

Prediction of fetal death in monochorionic twin pregnancies complicated by Type‐III selective fetal growth restriction

Mieghem

Lewi

Slaghekke

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?Fetal death in Type-III selective fetal growth restriction can be partially predicted. Oligohydramnios, larger intertwin weight discordance and, most prominently, early gestational age at diagnosis and deterioration in umbilical artery Doppler flow are associated with a higher risk of fetal death. High-risk, intermediate-risk and low-risk groups can be identified using clinical parameters. What are the clinical implications of this work?Our findings can help counsel patients regarding the individualized risk of fetal death for their pregnancy. The study demonstrates that it is possible to identify pregnancies at high or intermediate risk of fetal death, which could be monitored more closely and which could benefit from fetal intervention.

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“…Monochorionic (MC) twin pregnancies can be complicated by several problems, such as discordant congenital anomalies (DA), selective intrauterine growth restriction (sIUGR), twin-to-twin transfusion syndrome (TTTS), twin reversed arterial perfusion (TRAP) sequence or twin anemia-polycythemia sequence (TAPS) [ 1 , 2 ]. These conditions may jeopardize the entire pregnancy due to the presence of placental vascular anastomoses.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience

Weber

Strizek

Recker

et al. 2022

JCM

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Objectives: To review the outcome of complicated monochorionic pregnancies after fetoscopic selective feticide with bipolar cord coagulation in an experienced German center. Methods: All cases that underwent selective feticide using fetoscopic bipolar umbilical cord occlusion (and simultaneous dissection in monoamniotics) at the University of Bonn in the past 10 years were retrospectively analyzed for antenatal and neonatal course and outcome. An adverse outcome was defined as either intrauterine death (IUD), neonatal death (NND), preterm prelabour rupture of membranes (PPROM), or preterm delivery (PTD) before 32.0 weeks of gestation. Results: We diagnosed 56 monochorionic pregnancies, including 43 diamniotic and 8 monoamniotic twins, as well as 5 triplets, complicated by discordant fetal anomalies (n = 10), selective intrauterine growth restriction (n = 29), twin-to-twin transfusion syndrome (n = 13), twin reversed arterial perfusion sequence (n = 3), or severe early twin anemia polycythemia sequence (n = 1), that underwent fetoscopic selective feticide in the 10 years study period. Selective feticide was performed by bipolar cord coagulation at a median gestational age of 21.2 weeks. PPROM occurred in 11 cases, 7 (12.5%) before 32.0 weeks and 4 (7.1%) between 34.0 and 36.0 weeks, respectively. There were five (8.9%) co-twins IUDs at a median of 2 weeks after the intervention. We observed 12 (21.4%) PTDs before 32.0 weeks of gestation and 2 (3.6%) NNDs. Mean gestational age at delivery was 37.1 weeks, with an overall survival of the co-twin of 87.5%. Conclusion: In experienced hands, fetoscopic selective feticide is an effective treatment in complicated monochorionic pregnancies. By sacrificing a sick fetus that jeopardizes the entire pregnancy, a higher survival rate of the co-twin can be achieved.

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Outcome of monochorionic twin pregnancy complicated by Type‐III selective intrauterine growth restriction

Cited by 21 publications

References 25 publications

How to Better Distinguish between Type II and III Selective Fetal Growth Restriction in Monochorionic Twin Pregnancies?

How to Better Distinguish between Type II and III Selective Fetal Growth Restriction in Monochorionic Twin Pregnancies?

Prediction of fetal death in monochorionic twin pregnancies complicated by Type‐III selective fetal growth restriction

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience

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