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Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies
Affiliation:1. Academic Department of Development and Regeneration, Clinical Specialties Research Groups, Biomedical Sciences; Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium;2. Institute for Women''s Health and Institute of Child Health, University College London, London, UK;3. Great Ormond Street Hospital, London, UK;4. Erasmus Medical Centre, Sophia Hospital for Children, Intensive Care Unit for Children, Rotterdam, The Netherlands;1. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;2. Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China;3. Leiden University Medical Center, Leiden, Netherlands;1. Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children''s Fetal Center, Houston, TX, USA;2. Department of Pediatric Medicine, Neonatology, Baylor College of Medicine and Texas Children''s Hospital, Houston, TX, USA;3. Department of Pathology, Baylor College of Medicine and Texas Children''s Hospital, Houston, TX, USA;4. Department of Obstetrics and Gynecology, Women’s Health Hospital, Faculty of Medicine, Assiut University, Egypt;1. Department of Obstetrics, Saint Luc University Hospital, Université de Louvain, Brussels, Belgium;2. Department of Pathology, Saint Luc University Hospital, Université de Louvain, Brussels, Belgium;3. Department of Obstetrics, University Hospitals, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium;4. Institute for Women’s Health, University College London Medical School, London, United Kingdom;1. Department of Obstetrics, Guangzhou Women and Children''s Medical Center, Guangzhou, Guangdong, China;2. Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China;3. Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510655, China
Abstract:
Selective intrauterine growth restriction (sIUGR) affects 10–15% of all monochorionic pregnancies. Early severe forms are associated with intrauterine demise or neurological adverse outcome for both twins. The characteristics of umbilical artery (UA) Doppler in the IUGR fetus determine three clinical types: (I) normal UA Doppler and associated with good prognosis; (II) persistently absent/reverse UA end-diastolic flow and associated with early deterioration of the IUGR twin and very preterm delivery; (III) intermittently absent/reverse end-diastolic flow in the UA, and associated with unexpected fetal demise or neurological injury in one or both twins. Types II and III pose important challenges for management. Placental laser or cord occlusions do not seem to increase survival, but they might improve the outcomes of the larger twin. The use of an algorithm with severity criteria may help in counseling and planning management.
Keywords:Monochorionic twins  Selective intrauterine growth restriction (sIUGR)  Fetal therapy  Arterio-arterial anastomoses  Umbilical cord occlusion  Laser coagulation
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