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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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Complications of Monochorionic Diamniotic Twins: Stepwise Approach for Early Identification, Differential Diagnosis, and Clinical Management

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Maternal-fetal Medicine 2021年第1期3卷 42-52页

作者： Taita Micheletti Elisenda Eixarch Mar Bennasar Josep Maria Martinez Eduard Gratacos BCNatal-fetal Medicine Research Center(Hospital Clinic and Hospital Sant Joan de Deu) University of BarcelonaBarcelona 08028Spain Institut d'Investigacions Biomediques August Pi iSunyer(IDIBAPS) Barcelona 08036Spain Centre for Biomedical Research on Rare Diseases(CIBER-ER)Madrid 28029 Spain Institut de Recerca Sant Joan de Deu Esplugues de Llobregat 08950Spain

One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.

关键词： Acute feto-fetal transfusion Discordant malformation Monochorionic diamniotic twin pregnancy Pregnancy twin selective fetal growth restriction Single intrauterine fetal death Twin anemia-polycythemia sequence Twin-twin transfusion syndrome

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