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

Abstract

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.

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

“…Its dynamic nature hampers the determination of a “definitive” Gratacós type. At present, available studies base the classification of a pregnancy complicated by sFGR on either a single observation of abnormal UA Doppler flow patterns, the final UA Doppler flow pattern prior to delivery or the most prevalent Doppler flow pattern 17,24,26 . Therefore, the classification of sFGR according to Gratacós is still not uniformly applied in literature, leading to substantial incomparability between studies with regards to outcome per sFGR type.…”

“…At present, available studies base the classification of a pregnancy complicated by sFGR on either a single observation of abnormal UA Doppler flow patterns, the final UA Doppler flow pattern prior to delivery or the most prevalent Doppler flow pattern. 17,24,26 Therefore, the classification of sFGR according to Gratacós is still not uniformly applied in literature, leading to substantial incomparability between studies with regards to outcome per sFGR type. It was recently suggested that a modification of the Gratacós classification is necessary that includes GA at diagnosis, variation in UA Doppler flow patterns, ductus venosus Doppler (has been shown to be a powerful prognostic marker for sFGR and might identify infants with increased risk for neonatal mortality and morbidity 27 ) and the co-existence of TTTS.…”

“…Batsry et al (n = 12) and Aquino et al (n = 3) were the only cohorts in which severe cerebral injury did not occur 22,25. The highest severe cerebral injury rate of 33% (8/24) occurred in the cohort of Ishii et al (n = 13), which was born at a median GA of 31(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) weeks 11. Interestingly, Ishii et al…”

“…Ishii et al (n = 23) reported the highest median GA at birth of 36(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) weeks 11. Only 1/10 studies described indication of delivery.…”