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The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies
The present review aims to provide a critical appraisal of the sonographic diagnosis and follow-up and to evaluate the optimal clinical management of monochorionic twin pregnancies where one of the twins is complicated by selective fetal growth restriction (sFGR). The classification is based on the...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141888/ https://www.ncbi.nlm.nih.gov/pubmed/37109605 http://dx.doi.org/10.3390/medicina59040648 |
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author | Kozinszky, Zoltan Surányi, Andrea |
author_facet | Kozinszky, Zoltan Surányi, Andrea |
author_sort | Kozinszky, Zoltan |
collection | PubMed |
description | The present review aims to provide a critical appraisal of the sonographic diagnosis and follow-up and to evaluate the optimal clinical management of monochorionic twin pregnancies where one of the twins is complicated by selective fetal growth restriction (sFGR). The classification is based on the umbilical artery (UA) diastolic flow reflecting the outcome. If the sFGR twin has positive diastolic flow (Type I) then the prognosis is good, and it does not require close surveillance. Biweekly or weekly sonographic and Doppler surveillance and fetal monitoring are recommended strategies to detect unpredictable complications in type II and type III forms, which are defined by persistently absent/reverse end-diastolic flow (AREDF) or cyclically intermittent absent/reverse end-diastolic flow (iAREDF) in the umbilical waveforms, respectively. The latest forms are associated with an increased risk of unexpected fetal demise of the smaller twin and 10–20% risk of neurological injury in the larger twin in addition to the overall risk of prematurity. The clinical course can be affected by elective fetal therapy (‘dichorinization’ of the placenta with laser or selective fetal reduction) or elective delivery in the presence of severe fetal deterioration. The prediction of the clinical outcome in complicated cases of type II and III sFGR cases remains elusive. Novel routines in fetal and placental scans in order to predict neurological impairments and unexpected fetal death to optimize the delivery time-point are needed. |
format | Online Article Text |
id | pubmed-10141888 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-101418882023-04-29 The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies Kozinszky, Zoltan Surányi, Andrea Medicina (Kaunas) Review The present review aims to provide a critical appraisal of the sonographic diagnosis and follow-up and to evaluate the optimal clinical management of monochorionic twin pregnancies where one of the twins is complicated by selective fetal growth restriction (sFGR). The classification is based on the umbilical artery (UA) diastolic flow reflecting the outcome. If the sFGR twin has positive diastolic flow (Type I) then the prognosis is good, and it does not require close surveillance. Biweekly or weekly sonographic and Doppler surveillance and fetal monitoring are recommended strategies to detect unpredictable complications in type II and type III forms, which are defined by persistently absent/reverse end-diastolic flow (AREDF) or cyclically intermittent absent/reverse end-diastolic flow (iAREDF) in the umbilical waveforms, respectively. The latest forms are associated with an increased risk of unexpected fetal demise of the smaller twin and 10–20% risk of neurological injury in the larger twin in addition to the overall risk of prematurity. The clinical course can be affected by elective fetal therapy (‘dichorinization’ of the placenta with laser or selective fetal reduction) or elective delivery in the presence of severe fetal deterioration. The prediction of the clinical outcome in complicated cases of type II and III sFGR cases remains elusive. Novel routines in fetal and placental scans in order to predict neurological impairments and unexpected fetal death to optimize the delivery time-point are needed. MDPI 2023-03-24 /pmc/articles/PMC10141888/ /pubmed/37109605 http://dx.doi.org/10.3390/medicina59040648 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Kozinszky, Zoltan Surányi, Andrea The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies |
title | The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies |
title_full | The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies |
title_fullStr | The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies |
title_full_unstemmed | The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies |
title_short | The High-Risk Profile of Selective Growth Restriction in Monochorionic Twin Pregnancies |
title_sort | high-risk profile of selective growth restriction in monochorionic twin pregnancies |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141888/ https://www.ncbi.nlm.nih.gov/pubmed/37109605 http://dx.doi.org/10.3390/medicina59040648 |
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