Document Detail


Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies.
MedLine Citation:
PMID:  20661884     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Selective intrauterine growth restriction (sIUGR) occurs in 10 to 15% of monochorionic (MC) twins, and it is associated with a substantial increase in perinatal mortality and morbidity. Clinical evolution is largely influenced by the existence of intertwin placental anastomoses: pregnancies with similar degrees of fetal weight discordance are associated with remarkable differences in clinical behavior and outcome. We have proposed a classification of sIUGR into three types according to umbilical artery (UA) Doppler findings (I-normal, II-absent/reverse end-diastolic flow, III-intermittent absent/reverse end-diastolic flow), which correlates with distinct clinical behavior, placental features and may assist in counseling and management. In terms of prognosis, sIUGR can roughly be divided in two groups: type I cases, with a fairly good outcome, and types II and III, with a substantial risk for a poor outcome. Management of types II and III may consist in expectant management until deterioration of the IUGR fetus is observed, with the option of cord occlusion if this occurs before viability. Alternatively, active management can be considered electively, including cord occlusion or laser coagulation. Both therapies seem to increase the chances of intact survival of the larger fetus, while they entail, or increase the chances of, intrauterine demise of the IUGR fetus.
Authors:
Dan V Valsky; Elisenda Eixarch; Josep Maria Martinez; Eduard Gratacós
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Prenatal diagnosis     Volume:  30     ISSN:  1097-0223     ISO Abbreviation:  Prenat. Diagn.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-27     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106540     Medline TA:  Prenat Diagn     Country:  England    
Other Details:
Languages:  eng     Pagination:  719-26     Citation Subset:  IM    
Copyright Information:
(c) 2010 John Wiley & Sons, Ltd.
Affiliation:
Department of Maternal-Fetal Medicine (Institut Clínic de Ginecologia, Obstetrícia i Neonatologia), Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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MeSH Terms
Descriptor/Qualifier:
Diseases in Twins / physiopathology*,  ultrasonography
Female
Fetal Growth Retardation / physiopathology*,  ultrasonography
Humans
Placenta / physiopathology*,  ultrasonography
Pregnancy
Twins, Monozygotic*
Ultrasonography, Prenatal
Umbilical Arteries / ultrasonography

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