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Impact of different prenatal management strategies in short‐ and long‐term outcomes in monochorionic twin pregnancies with selective intrauterine growth restriction and abnormal flow velocity waveforms in the umbilical artery Doppler: a retrospective observational study of 108 cases
Author(s) -
Colmant C,
Lapillonne A,
Stirnemann J,
Belaroussi I,
LeroyTerquem E,
KermovantDuchemin E,
Bussieres L,
Ville Y
Publication year - 2021
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.16318
Subject(s) - medicine , intrauterine growth restriction , ductus venosus , obstetrics , umbilical artery , gestational age , twin pregnancy , population , umbilical cord , monochorionic twins , gestation , pregnancy , gynecology , genetics , environmental health , anatomy , biology
Objectives To review perinatal and neurodevelopmental outcome (NDO) following selective fetoscopic laser coagulation (SFLC), cord coagulation (CC) or expectant management of monochorionic diamniotic twin pregnancies complicated with selective intrauterine growth restriction (sIUGR) and absent or reverse end‐diastolic flow (AREDF) in the umbilical arteries (UA). Design and setting Single‐centre retrospective observational study. Population 108 cases of sIUGR diagnosed before 26 +6 weeks’ gestation with AREDF in the UA. Methods Survival rate and potential risk factors were analysed. NDO was assessed using parental questionnaires. Main outcomes measures Survival, gestational age at delivery and NDO. Results SFLC, CC and EM were performed in 13, 50 and 45 cases, respectively, with an overall survival of 23.1, 40 and 77.8% and intrauterine demise of the co‐twin of 30.8, 10 and 6.7% respectively. Intrauterine demise of the sIUGR twin occurred in 76.9 and 17.8% following SFLC and EM, respectively. The discordance in EFW at diagnosis was higher and absent/negative a‐wave in the ductus venosus (DV) was more prevalent in the surgical groups. NDO in survivors at follow up was abnormal in 0 and 18% in the smaller twin following SFLC and EM, respectively, and in 25, 24 and 21% in the larger twin following SFLC, CC and EM, respectively. Conclusion SFLC yielded a poor result. EM seems a valid option when EFW discordance is <30% and a‐wave in DV is positive. Otherwise, CC should be considered to protect the AGA co‐twin. The long‐term outcome of both small and large twins seems unaffected by the choice in primary prenatal management strategy. Tweetable abstract In type II sIUGR in MC twins, long‐term neurodevelopment is normal in over 80% of the survivors.