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Selective Fetal Growth Restriction in Monochorionic Diamniotic Twins: Diagnosis and Management

Maternal-Fetal Medicine 2022年第4期4卷 268-275页

作者： Alicia Mazer Zumaeta Maria Mar Gil Miguel Rodriguez-Fernandez Pilar Carretero JoséHector Ochoa Maria Cristina Casanova Francisca Sonia Molina Department of Obstetrics and Gynecology Hospital Universitario Clinico San CecilioGranada 18016Spain Department of Obstetrics and Gynecology Hospital Matemo Provincial Dr.Raul Felipe LuciniCordoba 500oArgentina Diagnus SA Prenatal Diagnosis and Fetal Medicine CenterCordoba 5000Argentina Obstetrics and Gynecology Department Hospital Universitario de TorrejonTorrejon de Ardoz 28223MadridSpain School of Medicine Universidad Francisco de VitoriaPozuelo de Alarcon 28223MadridSpain Instituto de Investigacion Biosanitaria lbs.GRANADA Granada 18016Spain

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.

关键词： Twins Monochorionic diamniotic twins Selective fetal growth restriction birthweight discordance Fetal therapy Placenta

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