Management and perinatal outcome of selective intrauterine growth restriction in monochorionic pregnancies

Sukhwani, Meghna; Antolín, E.; Herrero, Beatriz; Rodríguez, Roberto; Calle, María de la; López, F.R. Pérez; Bartha, José Luis

doi:10.1080/14767058.2019.1698030

Cited by 9 publications

(11 citation statements)

References 12 publications

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“…The referral time and hospital location influenced the final diagnostic gestational age. The results of this study indicated that the onset of sFGR II and III could occur at an earlier gestational age compared with sFGR I, which was consistent with previous findings 17,18 . Those authors also found that sFGR I had an earlier onset gestational age compared with sFGR II and III.…”

Section: Discussionsupporting

confidence: 92%

“…The results of this study indicated that the onset of sFGR II and III could occur at an earlier gestational age compared with sFGR I, which was consistent with previous findings. 17,18 Those authors also found that sFGR I had an earlier onset gestational age compared with sFGR II and III. Furthermore, the study by Couck et al 19 suggested that the proportion of sFGR II and III was significantly higher in early-onset sFGR than in late-onset sFGR.…”

Section: Discussionmentioning

confidence: 87%

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Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Wang

Yuan

et al. 2021

Acta Obstet Gynecol Scand

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Introduction This study aimed to explore the differences in placental characteristics among three types of selective fetal growth restriction (sFGR) in monochorionic diamniotic twin pregnancies. Material and methods A total of 123 placentas with sFGR between April 2013 and October 2019 were retrospectively analyzed after dye injection. Placental characteristics were compared among the three types. Results The gestational age at diagnosis and delivery was less in sFGR II and III than in sFGR I (22.9 [21.7–33.6], 23.3 [20.0–26.1] and 25.7 [19.0–35.0] weeks, p < 0.001; 32.3 [31.6–35.1], 34.1 [29.9–34.7] and 35.5 [34.0–37.0] weeks, p < 0.001). The birthweight discordance ratio was less in sFGR I than in sFGR II (0.28 [0.14–0.43] and 0.30 [0.23–0.37], p < 0.001). The prevalence of a thick artery–artery anastomosis was higher in sFGR III than in sFGR I or II (81.8%, 44.9% and 48.6%, p = 0.010). The placental territory discordance ratio was higher in sFGR II and III than in sFGR I (0.60 [0.17–0.88], 0.60 [0.01–0.80] and 0.50 [0.01–0.71], p = 0.001). Conclusions Compared with sFGR I, the earlier onset time of sFGR II and III might be due to their higher placental territory discordance. The prevalence of thick artery–artery anastomoses was expected to be higher in sFGR III than in sFGR I or II.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 87%

Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Wang

Yuan

et al. 2021

Acta Obstet Gynecol Scand

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“…( n = 26) and Sukhwani et al. ( n = 19) 12,15,19,22 . The lowest neonatal mortality rate was reported in the study with the highest GA at birth (Ishii et al 11 …”

Section: Resultsmentioning

confidence: 93%

Gestational age at birth and outcome in monochorionic twins with different types of selective fetal growth restriction: A systematic literature review

et al. 2022

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This systematic review aims to assess the gestational age at birth and perinatal outcome [intrauterine demise (IUD), neonatal mortality and severe cerebral injury] in monochorionic twins with selective fetal growth restriction (sFGR), according to Gratacós classification based on umbilical artery Doppler flow patterns in the smaller twin. Seventeen articles were included. Gestational age at birth varied from 33.0 to 36.0 weeks in type I, 27.6–32.4 weeks in type II, and 28.3–33.8 weeks in type III. IUD rate differed from 0%–4% in type I to 0%–40% in type II and 0%–23% in type III. Neonatal mortality rate was between 0%–10% in type I, 0%–38% in type II, and 0%–17% in type III. Cerebral injury was present in 0%–2% of type I, 2%–30% of type II and 0%–33% of type III cases. The timing of delivery in sFGR varied substantially among studies, particularly in type II and III. The quality of evidence was moderate due to heterogenous study populations with varying definitions of sFGR and perinatal outcome parameters, as well as a lack of consensus on the use of the Gratacós classification, leading to substantial incomparability. Our review identifies the urgent need for uniform antenatal diagnostic criteria and definitions of outcome parameters.

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“…12,13 Some studies have incorporated the International Society of Ultrasound in Obstetrics & Gynecology (ISUOG) 2015 sFGR definition where the EFW of 1 twin is <10% and inter-twin EFW discordance must be >25%. [14][15][16][17] Such inconsistencies limit the generalizability of antenatal management and perinatal outcomes.…”

mentioning

confidence: 99%

“…Other reported definitions of sFGR include EFW below 1.5 standard deviations for the growth‐restricted twin, 11 inter‐twin EFW discordance ≥25%, 8 and/or abdominal circumference <10% 12,13 . Some studies have incorporated the International Society of Ultrasound in Obstetrics & Gynecology (ISUOG) 2015 sFGR definition where the EFW of 1 twin is <10% and inter‐twin EFW discordance must be >25% 14–17 . Such inconsistencies limit the generalizability of antenatal management and perinatal outcomes.…”

mentioning

confidence: 99%

Selective Fetal Growth Restriction Type III

Chmait

Monson

Korst

et al. 2021

J of Ultrasound Medicine

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Objectives Per a recent expert definition, diagnosis of selective fetal growth restriction (sFGR) in monochorionic diamniotic twins is based on an estimated fetal weight (EFW) <3% as sole criterion and/or combinations of 4 contributory criteria (1 twin EFW <10%; 1 twin abdominal circumference <10%; EFW discordance ≥25%; and smaller twin umbilical artery [UA] pulsatility index >95th percentile). We assessed these criteria in sFGR Type III (intermittent absent or reversed end‐diastolic flow of the UA [iAREDF]) patients to test whether meeting the more stringent parameters of the consensus definition had worse outcomes, that is, progression to sFGR Type II (persistent AREDF) or twin‐twin transfusion syndrome; or secondarily, decreased dual survivorship. Methods This was a retrospective study of referred sFGR Type III patients (2006–2017). Patients were retrospectively categorized using consensus criteria for 2 comparisons: 1) EFW <3% versus remaining cohort; 2) EFW <3% or met all 4 contributory criteria versus remaining cohort. Results Forty‐eight patients were studied. Comparison 1: EFW <3% patients (58.3%) were not more likely to demonstrate disease progression (46.4% versus 65.0%, P = .2489) or worse dual survivorship (78.6% versus 85.0%, P = .7161). Comparison 2: EFW <3% or met all 4 contributory criteria (75.0%) patients were not more likely than the others to demonstrate progression (44.4% versus 83.3%, P = .0235) or worse dual survivorship (80.6% versus 83.3%, P = 1.0000). Conclusions In a referred cohort of sFGR Type III patients, there was no evidence that meeting more stringent parameters of the consensus definition was associated with disease progression or dual survivorship.

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Management and perinatal outcome of selective intrauterine growth restriction in monochorionic pregnancies

Cited by 9 publications

References 12 publications

Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Placental characteristics in different types of selective fetal growth restriction in monochorionic diamniotic twins

Gestational age at birth and outcome in monochorionic twins with different types of selective fetal growth restriction: A systematic literature review

Selective Fetal Growth Restriction Type III

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