1. Selective Fetal Growth Restriction in Monochorionic Diamniotic Twins: Diagnosis and Management
- Author
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Zumaeta, Alicia Mazer, Gil, Maria Mar, Rodriguez-Fernandez, Miguel, Carretero, Pilar, Ochoa, Jose Hector, Casanova, Maria Cristina, Molina, Francisca Sonia, [Zumaeta, Alicia Mazer] Hosp Univ Clin San Cecillo, Dept Obstet & Gynecol, Granada 18016, Spain, [Molina, Francisca Sonia] Hosp Univ Clin San Cecillo, Dept Obstet & Gynecol, Granada 18016, Spain, [Zumaeta, Alicia Mazer] Hosp Materno Prov Dr Raul Felipe Lucini, Dept Obstet & Gynecol, RA-5000 Cordoba, Argentina, [Zumaeta, Alicia Mazer] Diagnus SA, Prenatal Diag & Fetal Med Ctr, RA-5000 Cordoba, Argentina, [Ochoa, Jose Hector] Diagnus SA, Prenatal Diag & Fetal Med Ctr, RA-5000 Cordoba, Argentina, [Gil, Maria Mar] Hosp Univ Torrejon, Obstet & Gynecol Dept, Madrid 28223, Spain, [Rodriguez-Fernandez, Miguel] Hosp Univ Torrejon, Obstet & Gynecol Dept, Madrid 28223, Spain, [Casanova, Maria Cristina] Hosp Univ Torrejon, Obstet & Gynecol Dept, Madrid 28223, Spain, [Gil, Maria Mar] Univ Francisco Vitoria, Sch Med, Madrid 28223, Spain, [Carretero, Pilar] Univ Francisco Vitoria, Sch Med, Madrid 28223, Spain, and [Molina, Francisca Sonia] Inst Invest Biosanitaria Ibs GRANADA, Granada 18016, Spain
- Subjects
Intermittent absent ,Fetal therapy ,Selective fetal growth restriction ,End-diastolic flow ,Photocoagulation ,Monochorionic diamniotic twins ,Placenta ,Ultrasound ,Twins ,Pregnancies ,Birthweight discordance ,Umbilical artery doppler - Abstract
Selective fetal growth restriction (sFGR) is a severe condition that complicates 10% to 15% of all monochorionic diamniotic (MCDA) twin pregnancies. Pregnancies complicated with sFGR are at high risk of intrauterine demise or adverse perinatal outcome for the twins. Three clinical types have been described according to the umbilical artery (UA) Doppler pattern observed in the smaller twin: type I, when the UA Doppler is normal; type II, when there is persistent absent or reversed end-diastolic blood flow in the UA Doppler; and type III, when there is intermittent absent and/or reversed end-diastolic blood flow in the UA Doppler. Clinical evolution and management options mainly depend on the type of sFGR. Type I is usually associated with a good prognosis and is managed conservatively. There is no consensus on the management of types II and III, but in earlier and more severe presentations, fetal interventions such as selective laser photocoagulation of placental anastomoses or selective fetal cord occlusion of the smaller twin may be considered. This review aims to provide updated information about the diagnosis, evaluation, follow-up, and management of sFGR in MCDA twin pregnancies.
- Published
- 2022