Diagnosis and Management of Selective Fetal Growth Restriction in Monochorionic Twins

Abstract

Selective fetal growth restriction (sFGR) has been reported to occur in about 10–15% of monochorionic (MC) twins. The diagnosis of sFGR has been based on variable criteria including estimated fetal weight (EFW), abdominal circumference and/or the degree of fetal weight discordance. Recent studies tend to use a simple definition which includes the presence of an EFW less than the 10th percentile in the smaller twin. Some would argue that the intertwin fetal weight discordance should be included in the definition. Indeed this factor plays a major role in the complications presented by these cases. While the majority of cases with one fetus below the 10th percentile usually will also present with a large intertwin EFW discordance, the contrary is not always true. Thus, it is possible to find MC twins with remarkable intertwin EFW discordance but the EFW of both fetuses are still within normal ranges. Although it appears to be common sense that a large intertwin discrepancy might represent a higher risk for some of the complications described later in this review, there is no consistent evidence to support this notion. Therefore, due to its simplicity, a definition based on an EFW below 10th percentile in one twin is probably the most useful for clinical and research purposes.

Metabolic dynamics and prediction of sFGR and adverse fetal outcomes: a prospective longitudinal cohort study

“…Neonatal brain injury is a serious adverse outcome in MCDA twins, and those with sFGR suffer from higher morbidity and severity [1,7,46,47]. Consistent with this, the incidence of brain injury in the sFGR group was higher than that in the MCDA group according to the cerebral ultrasonography results of all neonates in the cohort, including abnormal brain structure, choroid plexus, and white matter damage (Fig.…”

“…Clinically, MCDA twins with a higher rate of discordance often have more serious adverse outcomes, including intrauterine fetal death [7,45]. Hence, we performed a correlation analysis between maternal metabolites and the differences (diff ) in physical development parameters of pairs of twins.…”

“…It significantly increases the risk of perinatal mortality and long-term adverse infant neurological outcomes [1], affecting approximately 15% of MCDA twin pregnancies [3,4]. Currently, the diagnosis and classification of sFGR can only rely on ultrasonography findings in the second or third trimester [7], and fetal brain injury is often assessed after birth, which hinders early intervention with sFGR and fetal brain injury in clinical settings.…”