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

Abstract

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.

Predictors of Poor Outcomes in Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Fetal Growth Restriction

“…The substantial number of FGR fetuses less than the 3rd percentile and the average intertwin EFW discordance of 29% in the study cohort are reflective of that. Previous studies have examined perinatal outcomes according to the type of sFGR with poor outcomes reported with type II and type III sFGR [11][12][13]17]. The risk of fetal deterioration is high in type II cases with a 30-50% risk of demise in the smaller twin and 22-25% of the appropriately grown twin [11,17].…”

“…The risk of fetal deterioration is high in type II cases with a 30-50% risk of demise in the smaller twin and 22-25% of the appropriately grown twin [11,17]. Type III sFGR is associated with an unpredictable course, including sudden demise of the growth-restricted twin and neurological injury to the appropriately grown twin [1,13]. In this study, even though there was a higher proportion of type II and type III sFGR cases in the one or no survivor category as compared to two survivors to discharge, the difference was not significant.…”

“…Type II carries the worst prognosis as 90% of the smaller twins eventually demonstrate deterioration and impending demise [11,12]. Type III has a very unpredictable course with a 15-20% risk of deterioration or impending demise of the smaller twin and a 15-30% risk for neurological injury for the appropriately grown fetus [1,7,13]. The objective of this study was to identify additional variables to be used as predictors of perinatal loss and poor outcomes aside from UA Doppler abnormalities in MCDA twin pregnancies complicated by sFGR.…”

Single fetal demise in monochorionic twins: How to predict cerebral injury in the survivor co‐twin?

“…19 A sudden death of the smaller fetus may result in the exsanguination of the larger twin through a large AA anastomosis: a severe hypovolemic event resulting in brain damage. 20 Regarding TTTS, survivor fetuses have been shown to be at increased risk of abnormal neurodevelopment compared to uncomplicated MC twins: before the introduction of FPL its incidence was reported to be between 17 and 42% 21 but nowadays FPL has decreased the rate to 4%-18%. 22 Risk of cerebral damage seems higher when sigle fetal demise affects to the recipient twin instead of the donor one.…”

“…Type‐III s‐IUGR is characterized by unequal placental sharing with large bidirectional artery‐to‐artery (AA) intertwin anastomoses, allowing for acute hemodynamic shift from one fetus to the other 19 . A sudden death of the smaller fetus may result in the exsanguination of the larger twin through a large AA anastomosis: a severe hypovolemic event resulting in brain damage 20 . Regarding TTTS, survivor fetuses have been shown to be at increased risk of abnormal neurodevelopment compared to uncomplicated MC twins: before the introduction of FPL its incidence was reported to be between 17 and 42% 21 but nowadays FPL has decreased the rate to 4%–18% 22 …”