Document Detail

Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas.
MedLine Citation:
PMID:  20675206     Owner:  NLM     Status:  MEDLINE    
Selective intrauterine growth restriction (sIUGR) in monochorionic twins is associated with a substantial increase in perinatal mortality and morbidity for both twins. Clinical evolution depends on the combination of the effects of placental insufficiency in the IUGR twin with inter-twin blood transfer through placental anastomoses. Classification of sIUGR into types according to the characteristics of umbilical artery diastolic flow in the IUGR twin permits the differentiation of clinical and prognostic groups. sIUGR type I has normal diastolic flow and relatively good outcome. Type II is defined by persistently absent/reverse end-diastolic flow and is associated with a high risk of intrauterine demise of the IUGR twin and/or very preterm delivery. Type III is defined by the presence of intermittent absent/reverse end-diastolic flow (iAREDF), and is associated with 10-20% risk of unexpected fetal demise of the smaller twin and 10-20% risk of neurological injury in the larger twin. The management strategy for sIUGR with abnormal umbilical artery Doppler (types II and III) remains a challenge, and may include elective fetal therapy or close surveillance with fetal therapy or elective delivery in the presence of severe fetal deterioration. Small clinical series reporting the use of cord occlusion or laser therapy in severe cases suggest that the outcome of the larger twin might be improved. There is probably no single optimal strategy, since decisions will ultimately be influenced by the severity of IUGR, gestational age, parents' wishes and technical issues.
Dan V Valsky; Elisenda Eixarch; Josep Maria Martinez; Fatima Crispi; Eduard Gratacós
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2010-08-03
Journal Detail:
Title:  Seminars in fetal & neonatal medicine     Volume:  15     ISSN:  1878-0946     ISO Abbreviation:  Semin Fetal Neonatal Med     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-10-18     Completed Date:  2011-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101240003     Medline TA:  Semin Fetal Neonatal Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  342-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010. Published by Elsevier Ltd.
Department of Maternal-Fetal Medicine (Institut Clínic de Ginecologia, Obstetrícia i Neonatologia), Hospital Clinic-IDIBAPS, University of Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBER-ER), Spain.
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MeSH Terms
Diseases in Twins / physiopathology,  prevention & control*
Fetal Growth Retardation / physiopathology,  prevention & control*
Fetal Therapies
Fetofetal Transfusion / therapy,  ultrasonography*
Placental Insufficiency / therapy,  ultrasonography*
Regional Blood Flow
Twins, Monozygotic*
Ultrasonography, Doppler
Ultrasonography, Prenatal*
Umbilical Arteries / ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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