Prediction of adverse pregnancy outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction

Monaghan, Caitriona; Kalafat, Erkan; Binder, Julia; Thilaganathan, B.; Khalil, Asma

doi:10.1002/uog.19078

Cited by 46 publications

(41 citation statements)

References 29 publications

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“…Gratacós et al . classified sFGR into three types, each of which has a different clinical evolution and perinatal outcome. In our study, Type I sFGR was the most frequent in both early‐ and late‐onset sFGR, accounting for 80.8% and 94.4% of cases, respectively.…”

Section: Discussionmentioning

confidence: 58%

Early‐ and late‐onset selective fetal growth restriction in monochorionic diamniotic twin pregnancy: natural history and diagnostic criteria

Curado

Sileo

Bhide

et al. 2020

Ultrasound in Obstet & Gyne

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CONTRIBUTIONWhat are the novel findings of this work? Using a well-characterized unselected population of monochorionic diamniotic (MCDA) pregnancies, we have provided insight into the natural history of selective fetal growth restriction (sFGR), according to gestational age at onset, as well as the risk of superimposed twin-to-twin transfusion syndrome. Different diagnostic criteria of sFGR were applied and compared in this population. What are the clinical implications of this work?This study describes the outcome of a population of MCDA twin pregnancies managed expectantly. The findings provide valuable information for better and more accurate counseling of parents. ABSTRACTObjectives To evaluate the natural history and outcome of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancy, according to gestational age at onset and various reported diagnostic criteria, and to quantify the risk of superimposed twin-to-twin transfusion syndrome (TTTS).Methods This was a cohort study of MCDA twin pregnancies that had their routine antenatal care from the first trimester at St George's Hospital, London, UK. Pregnancies had ultrasound examinations every 2 weeks at 16-24 weeks and then every 2-3 weeks until delivery. The diagnostic criteria for sFGR were estimated fetal weight (EFW) of one twin < 10 th centile and intertwin EFW discordance ≥ 25%. We also applied other diagnostic criteria reported in a recent Delphi consensus. Pregnancies in which the diagnosis of TTTS was made before that of sFGR were not included in the Correspondence to: analysis. Pregnancies that underwent fetal intervention for sFGR were excluded. The incidence of sFGR was compared between the different diagnostic criteria, overall and according to gestational age at onset. In all subsequent analyses, cases of sFGR included those diagnosed according to any of the criteria. The Gratacós classification of sFGR was applied (Type I, II or III). Pregnancy outcomes included miscarriage, intrauterine death, neonatal death and admission to the neonatal unit. Comparisons between groups were carried out using the Mann-Whitney U-test for continuous variables and the chi-square or Fisher's exact test for categorical variables. ResultsThe analysis included 287 MCDA twin pregnancies. According to the International Society of Ultrasound in Obstetrics and Gynecology diagnostic criteria, the incidence of early (< 24 weeks) sFGR was 4.9%, while that of late sFGR was 3.8%. When applying the various diagnostic criteria, the incidence of early sFGR varied from 1.7% to 9.1% and that of late sFGR varied from 1.1% to 5.9%. In early-onset cases, the incidence of Type I sFGR was 80.8%, that of Type II was 15.4% and that of Type III was 3.8%. The corresponding figures in late-onset cases were 94.4%, 5.6% and 0%. The incidence of superimposed TTTS was 26.9% in cases affected by early-onset sFGR and 5.6% in those affected by late-onset sFGR. The incidence of perinatal death was 8.0% in early-onset sFGR and 5.6% in late-onset sFGR (P = 0.661)...

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Section: Discussionmentioning

confidence: 58%

Early‐ and late‐onset selective fetal growth restriction in monochorionic diamniotic twin pregnancy: natural history and diagnostic criteria

Curado

Sileo

Bhide

et al. 2020

Ultrasound in Obstet & Gyne

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“…Monitoring of Type‐III sFGR is particularly challenging since IUD is unpredictable and the risk of neurological injury to the larger twin is substantial. Known adverse predictors in sFGR include earlier gestational age at diagnosis, ductus venosus Z ‐score, cord insertion site and fetal weight discrepancy, but further development of prognostic markers for severe sFGR is needed. In general, severe sFGR with normal venous Doppler can be managed expectantly with frequent Doppler, biophysical profile and cardiotocographic evaluations.…”

Section: Discussionmentioning

confidence: 99%

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

Townsend

D’Antonio

Sileo

et al. 2019

Ultrasound in Obstet & Gyne

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Type I sFGR is characterized by good perinatal outcome with expectant management, which represents the most reasonable management strategy for the large majority of affected cases. Pregnancies complicated by Type II and III sFGR treated with fetoscopic laser ablation had higher mortality but lower morbidity compared to those managed expectantly, supporting the use of fetal therapy at gestations remote from neonatal viability - with scarce data on outcome following selective reduction. However, in view of the lack of evidence from randomized controlled trials, prenatal management of sFGR should be individualized according to gestational age at diagnosis, severity of growth discordance and magnitude of Doppler anomalies. This article is protected by copyright. All rights reserved.

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“…The chorionicity was determined based on the number of placentas and the presence or absence of the lambda sign at the intertwin membrane–placenta junction, as well as the intertwin membrane thickness at the site of its insertion in the chorion at 11–14 weeks, or the number of placentas and the fetal gender after 14 weeks’ gestation [ 14 , 15 , 16 ]. Gestational age (GA) was determined according to the crown-rump length (in the first trimester) or head circumference (after 14 weeks’ gestation) of the larger fetus in cases of spontaneous conception and according to the timing of in vitro fertilization for pregnancies conceived via assisted reproductive technology [ 14 , 17 , 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

Giorgione

Bhide

Bhate

et al. 2020

JCM

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Studies have reported controversial findings on the association between fetal growth restriction (FGR) or intertwin weight discordance and the risk of hypertensive disorders of pregnancy (HDP) in twin pregnancies. The aim of this study was to investigate the association between twin growth disorders and HDP. Twin pregnancies resulting in two live births at St George’s Hospital between 2000 and 2019 were included. FGR or small-for-gestational-age (SGA) at birth was assessed using singleton and twin reference charts. Intertwin discordance [(large birthweight − small birthweight)/(large birthweight) × 100%)] was calculated. Logistic regression models were performed. SGA (aOR 2.34, 95% CI 1.60–3.44, p < 0.001), intertwin discordance ≥25% (aOR 2.10, 95% CI 1.26–3.49, p = 0.004) and their co-existence (aOR 2.03, 95% CI 1.16–3.54, p = 0.013) were significantly associated with HDP. After adjusting for the known maternal risk factors of HDP and the intertwin discordance, SGA (using the twin charts) was the strongest independent risk factor associated with HDP (aOR 2.12, 95% CI 1.40–3.22, p < 0.001) and preeclampsia (aOR 2.34, 95% CI 1.45–3.76, p < 0.001). This study highlights that the presence of at least one SGA twin is significantly associated with HDP during pregnancy. Therefore, maternal blood pressure should be closely monitored in twin pregnancies complicated by SGA with or without intertwin discordance.

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Prediction of adverse pregnancy outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction

Cited by 46 publications

References 29 publications

Early‐ and late‐onset selective fetal growth restriction in monochorionic diamniotic twin pregnancy: natural history and diagnostic criteria

Early‐ and late‐onset selective fetal growth restriction in monochorionic diamniotic twin pregnancy: natural history and diagnostic criteria

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

Are Twin Pregnancies Complicated by Weight Discordance or Fetal Growth Restriction at Higher Risk of Preeclampsia?

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