Growth patterns of monochorionic twin pregnancy complicated by <scp>Type‐III</scp> selective fetal growth restriction

Shinar, Shiri; Xing, Wen; Lewi, Liesbeth; Slaghekke, Femke; Yinon, Yoav; Raio, Luigi; Baud, David; DeKoninck, Philip; Melamed, Nir; Huszti, Ella; Sun, Luming; Mieghem, Tim Van

doi:10.1002/uog.23752

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…Interestingly, the “reversal” phenomenon, that is, reverting to type I sIUGR from type II or III, was also observed in the present study. Recently, Shinar et al 24 assessed the fetal growth and Doppler patterns in type III sIUGR and found normalization of UA Doppler results in improved growth of the smaller fetus. Due to the small sample size, Doppler normalization and improvement in small fetal growth in types II and III sIUGR need to be confirmed by further observation.…”

Section: Discussionmentioning

confidence: 99%

Natural evolution and risk factors for adverse outcome in selective intrauterine growth restriction under expectant management: A retrospective observational study

Chen

Zhou

Zhang

et al. 2023

Intl J Gynecology & Obste

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Selective intrauterine growth restriction (sIUGR) accounts for approximately 10%-15% of monochorionic diamniotic (MCDA) twins and is one of the most severe complications. 1 Selective IUGR is associated with increased perinatal mortality rate, poor neurological outcome, and higher incidence of endocrine and metabolic diseases, as well as cardiovascular dysfunction in adulthood. 2 The pathogeneses of sIUGR rely not only on the presence of gross placental structure factors, such as abnormal placental sharing and aberrant cord insertion, but also on the magnitude and direction of blood-flow interchange through the placental anastomoses. 3 The umbilical artery (UA) Doppler flow pattern of the smaller twin has been used for classifying

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Section: Discussionmentioning

confidence: 99%

Natural evolution and risk factors for adverse outcome in selective intrauterine growth restriction under expectant management: A retrospective observational study

Chen

Zhou

Zhang

et al. 2023

Intl J Gynecology & Obste

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“…Since the development of this staging system, subsequent studies have addressed the natural history and clinical outcomes of monochorionic twins complicated by various degrees of FGR. In a recent multisite cohort of 328 monochorionic twins with type III FGR, mean gestational age at diagnosis of was 22.0 ± 4.6 (range 14.7–32.7) weeks, much earlier than the typical divergence in growth seen at 28–30 weeks seen between twin and singleton gestations [42]. In a recent systematic review assessing outcomes from 17 articles on the natural history of monochorionic twins with FGR, in-utero demise occurred in 0–4% in type I, 0–40% in type II, and 0–23% in type III [43].…”

Section: Selective Fetal Growth Restriction Complicating Monochorioni...mentioning

confidence: 94%

Fetal growth disorders in twin gestations

Blumenfeld

Anderson

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewTwin gestations account for approximately 3% of all births. Although there appear to be physiologic differences in the third trimester growth of twins compared with singleton gestations, reasons for this remain unclear. As growth-restricted fetuses and neonates are at increased risk for adverse outcomes, there is a clinical need to optimize our ability to delineate normally from pathologically grown twins.Recent findingsRecent studies have addressed current limitations in the way growth restriction is diagnosed in twin gestations. Twin-specific fetal and neonatal growth charts have been shown to decrease the number of cases inappropriately labeled as growth restricted compared with singleton nomograms. In addition, individual growth assessment (IGA) is a promising method of diagnosing pathological growth using each fetus's growth potential rather than a comparison of the estimated fetal weight with population nomograms.SummaryThere is a recent focus on improving our understanding of physiologic and pathologic twin growth. The increased use of twin-specific growth curves is likely to result in a decrease in the incidence of FGR diagnosis among twin gestations and could improve the outcomes of twins currently misclassified as FGR. Future research will hopefully clarify the reasons behind differences seen in twin versus singleton third trimester twin growth.

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“…All pregnancies underwent EFW measurement on ultrasound, amniotic fluid assessment and fetal Doppler evaluation at least once every 2 weeks. The baseline characteristics, fetal growth pattern, management protocol and outcome of these pregnancies have been published previously 10,12 .…”

Section: Methodsmentioning

confidence: 99%

“…We have documented previously the outcome and fetal growth patterns of a large international cohort of pregnancies complicated by Type-III sFGR 10,12 . The aim of the present study was to assess comprehensively the factors associated with spontaneous fetal death in the same cohort and to evaluate how these factors could be integrated into a prenatal management protocol.…”

Section: Introductionmentioning

confidence: 99%

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

Mieghem

Lewi

Slaghekke

et al. 2022

Ultrasound in Obstet & Gyne

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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.

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Growth patterns of monochorionic twin pregnancy complicated by Type‐III selective fetal growth restriction

Cited by 7 publications

References 20 publications

Natural evolution and risk factors for adverse outcome in selective intrauterine growth restriction under expectant management: A retrospective observational study

Natural evolution and risk factors for adverse outcome in selective intrauterine growth restriction under expectant management: A retrospective observational study

Fetal growth disorders in twin gestations

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

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