Twin pregnancy complicated by selective growth restriction

Townsend, Rosemary; Khalil, Asma

doi:10.1097/gco.0000000000000326

Cited by 27 publications

(38 citation statements)

References 24 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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“…In Type‐I sFGR pregnancy, both twins have normal end‐diastolic flow (EDF) in the UAs, in Type‐II there is absent or reversed EDF and, in Type III, the phenomenon of intermittently absent or reversed EDF is observed. A consensus agreement on the diagnostic criteria for sFGR in monochorionic pregnancy was published recently, but clinical uncertainty regarding the optimal management, particularly in very preterm gestations persists. The particular challenge in monochorionic pregnancy is the risk of acute fetofetal transfusion in the event of demise or profound hypotension in one twin causing death or neurological injury in the cotwin.…”

Section: Introductionmentioning

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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“…sFGR is seen less commonly in dichorionic (DC) than monochorionic (MC) twin pregnancies, with a reported prevalence of 10.5% compared to 19.7%, respectively [2]. DC twin pregnancies are believed to have a lower perinatal mortality rate than MC twins (33 per 1000 vs. 75 per 1000) [3], as well as a lower rate of neurological co-morbidities [4]. The recommended management for sFGR in DC twin pregnancies is the same as that of growth restricted singletons [1,5].…”

Section: Introductionmentioning

confidence: 99%

“…However, the evidence available to support this is scarce [6], and most of the literature on this subject largely focuses on MC twins. sFGR in MC twins is thought to be caused by an unequal sharing of the placenta and distribution of blood through placental anastomoses [7], whereas in DC twins, from placental insufficiency in one of the placentas [4]-explaining the higher incidence of pre-eclampsia in DC than MC twins with sFGR [8]. Other causes can include congenital infections, or discordant anomalies, which can be excluded through detailed ultrasound assessment, maternal serology and invasive prenatal testing [5].…”

Section: Introductionmentioning

confidence: 99%

Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome

Antonakopoulos

Pateisky

Liu

et al. 2020

JCM

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This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention.

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Twin pregnancy complicated by selective growth restriction

Cited by 27 publications

References 24 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

Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome

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