Prevalence of umbilical artery Doppler waveform abnormality during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic twin pregnancies: A prospective cohort study

Nakanishi, Kentaro; Muto, Haruka; Yamamoto, Ryo; Kawaguchi, Haruna; Hayashi, Satoru; Ishii, Keisuke

doi:10.1111/jog.14799

Cited by 4 publications

(3 citation statements)

References 34 publications

(51 reference statements)

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“…21 However, another prospective study shows that abnormal UA is presented in a small part of uncomplicated twins in the second trimester, and most of them can achieve normalization, which seems that the routine monitoring for UA is not necessary. 22 Hence, the assessment of UA Doppler is still unclear. However, it is known that complications such as TTTS result from long-lasting transfusion and hemodynamic imbalance; hence, it is possible that the UA Doppler waveforms deteriorate before TTTS can be diagnosed, and routine monitoring thus seems reasonable in this situation.…”

Section: The Dilemma Of Ultrasound Surveillance In Twin Pregnancymentioning

confidence: 99%

“…Another study shows that abnormal UA Doppler in the midtrimester indicates poor outcome, and therefore, close surveillance is warranted in all MC twins 21 . However, another prospective study shows that abnormal UA is presented in a small part of uncomplicated twins in the second trimester, and most of them can achieve normalization, which seems that the routine monitoring for UA is not necessary 22 . Hence, the assessment of UA Doppler is still unclear.…”

Section: Determination Of Chorionicity Of Twin Pregnancymentioning

confidence: 99%

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The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

Liu

Zhao

et al. 2022

Maternal Fetal Med

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The rate of multiple pregnancy is increasing, mainly because of the widespread use of assisted reproduction techniques and families’ desire for twins. Twin pregnancy accounts for a higher risk of chromosomal abnormalities, structural malformations, and neonatal adverse events than singleton pregnancy. The presence of artery-vein anastomoses, unbalanced placenta sharing, and abnormal cord insertion in monochorionic twins is associated with twin complications such as twin-to-twin transfusion syndrome, selective intrauterine growth restriction, and twin anemia polycythemia sequence. Although many guidelines and studies have established and improved the processes about the antenatal surveillance and management of twin pregnancy, they also raise more controversies and challenges. This review aims to highlight the international consensus on the antenatal care of twin pregnancies and analyze the controversies and predicaments based on the published International Federation of Gynecology and Obstetrics guidelines and research.

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Section: The Dilemma Of Ultrasound Surveillance In Twin Pregnancymentioning

confidence: 99%

Section: Determination Of Chorionicity Of Twin Pregnancymentioning

confidence: 99%

The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

Liu

Zhao

et al. 2022

Maternal Fetal Med

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show abstract

“…Selective fetal growth restriction (sFGR), characterized by growth discordance between monochorionic twins, occurs in 10-15% of monochorionic twin pregnancies [1][2][3][4] . Both twins, not just the one with growth restriction (FGR), may be affected by perinatal morbidity and mortality [5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Infant outcome at 3 years of age of monochorionic twins with Type‐II or ‐III selective fetal growth restriction and isolated oligohydramnios that underwent fetoscopic laser photocoagulation

Yamamoto,

Ozawa,

Wada

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectiveThis study aimed to examine infantile outcomes at 3 years of age with selective fetal growth restriction (sFGR) Types II and III with isolated oligohydramnios who underwent fetoscopic laser photocoagulation (FLP).MethodsThis multicenter prospective cohort study included monochorionic diamniotic twins who underwent FLP for sFGR between 16 and 25 weeks of gestation. The indication for performing FLP was in cases of sFGR Type II or III with oligohydramnios, where the maximal vertical pocket was ≤2 cm among twins with FGR. This was done in the absence of a typical twin‐twin transfusion syndrome diagnosis. The primary outcome was the intact survival (IS) rate of infants at the corrected age of 40 weeks and 3 years. IS at the corrected age of 40 weeks was defined as survival without grade III or IV intraventricular hemorrhage or cystic periventricular leukomalacia, and IS at 3 years of age was defined as survival without neurodevelopmental morbidity, including cerebral palsy, neurodevelopmental impairment with a total developmental quotient of ≤70, bilateral deafness, or bilateral blindness.ResultsAmong 45 patients with sFGR, 30 (66.7%) were classified as having Type II and 15 (33.3%) as Type III sFGR. The prevalence of IS at the corrected age of 40 weeks was 51.1% (n=23) in FGR twins and 95.5% (n=42) in larger twins. The prevalence of IS at 3 years of age was 46.7% (n=21) in FGR twins and 86.4% (n=38) in larger twins. Among the 24 FGR twins who were not diagnosed with IS at 3 years of age, 91.7% (22 of 24 cases) suffered fetal or infantile demise other than miscarriage and neurodevelopmental impairment. All larger twins who were not diagnosed with IS at 3 years of age (n=6, 13.6%) had neurological morbidity, in addition to one case of miscarriage.ConclusionsFGR twins and larger twins, when subjected to FLP due to sFGR coupled with umbilical artery Doppler abnormalities and isolated oligohydramnios, exhibit low rates of neurological morbidity and low mortality, respectively. Therefore, FLP for Type II or III sFGR with oligohydramnios may be a feasible and preferable management option.This article is protected by copyright. All rights reserved.

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Selective intrauterine growth restriction without concomitant twin-to-twin transfusion syndrome, natural history, and risk factors for fetal death: A systematic review and meta-analysis

Mustafa,

Javinani,

Heydari

et al. 2023

American Journal of Obstetrics & Gynecology MFM

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Prevalence of umbilical artery Doppler waveform abnormality during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic twin pregnancies: A prospective cohort study

Cited by 4 publications

References 34 publications

The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

The Controversies and Challenges in the Management of Twin Pregnancy: From the Perspective of International Federation of Gynecology and Obstetrics Guidelines

Infant outcome at 3 years of age of monochorionic twins with Type‐II or ‐III selective fetal growth restriction and isolated oligohydramnios that underwent fetoscopic laser photocoagulation

Selective intrauterine growth restriction without concomitant twin-to-twin transfusion syndrome, natural history, and risk factors for fetal death: A systematic review and meta-analysis

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