Selective intrauterine growth restriction in monochorionic twins: changing patterns in umbilical artery Doppler flow and outcomes

Abstract

Risk stratification based on UA Doppler is useful for planning ultrasound surveillance. However, patterns can change over time, with important consequences for management and outcome. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta‐analysis

“…There were eight studies (332 twins) on expectant management in Type‐I sFGR, one study (six fetuses) reporting the outcome of pregnancies complicated by Type‐I sFGR treated with laser therapy of placental anastomoses, and two studies (six twins) reporting the outcome of Type‐I sFGR treated with SR of the smaller twin (Table , Figure a).…”

“…In the present review, PND was rare in Type‐I sFGR cases, since all pregnancies in studies reporting neonatal survival had at least one surviving infant and none had severe neurological morbidity. We identified three studies (nine pregnancies) reporting fetal therapy in Type‐I sFGR. The study by Quintero et al .…”

“…The study by Quintero et al . predates the Gratacós classification and clarity on the prognostic value of UA Doppler, Rustico et al . offered cord occlusion in cases classified as Type‐I sFGR with later deterioration and Peng et al .…”

“…Weekly sonographic and Doppler surveillance is recommended in expectant management of Type‐I sFGR because disease progression occurs in up to 25%, with elective delivery between 34–36 weeks. Expectant management of severe sFGR (Types II and III) would benefit from a clear protocol identifying appropriate triggers for intervention.…”

Variation in outcome reporting across studies evaluating interventions for selective fetal growth restriction

“…MEDLINE, EMBASE, CINAHL, http://clinicaltrials.gov and The Cochrane Library databases were searched electronically using a comprehensive search strategy (Appendix S1). Thirty‐nine studies were included in the analysis, comprising 21 retrospective and 13 prospective cohort studies, three non‐comparative studies, one case–control and one cross‐sectional study (Table ). Fetal, neonatal and perinatal mortality were reported commonly across the included studies.…”