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Review
. 2022 Sep 21;4(4):268-275.
doi: 10.1097/FM9.0000000000000171. eCollection 2022 Oct.

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

Alicia Mazer Zumaeta  1   2   3 , María Mar Gil  4   5 , Miguel Rodríguez-Fernández  4 , Pilar Carretero  5 , José Hector Ochoa  3 , María Cristina Casanova  4 , Francisca Sonia Molina  1   6
Affiliations
Review

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

Alicia Mazer Zumaeta et al. Matern Fetal Med. .

Erratum in

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.

Keywords: Birthweight discordance; Fetal therapy; Monochorionic diamniotic twins; Placenta; Selective fetal growth restriction; Twins.

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Figures

Figure 1
Figure 1
Abdominal circumference discordance in monochorionic twin affected by selective fetal growth restriction.
Figure 2
Figure 2
Umbilical artery pulsed Doppler showing persistent absent end-diastolic flow in a case of selective fetal growth restriction type II.
Figure 3
Figure 3
Umbilical artery pulsed Doppler showing intermittently absent or reversed end-diastolic flow in a case of selective fetal growth restriction type III.
Figure 4
Figure 4
Fetoscopic view of umbilical cord before cord occlusion.
Figure 5
Figure 5
The targeted umbilical cord is visualized and grasped with the diathermy forceps.
See this image and copyright information in PMC

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