Selective fetal growth restriction (sFGR) is a severe condition that complicates 10% to 15% of all monochorionic diamniotic (MCDA) twin pregnancies. Pregnancies complicated with sFGR are at high risk of intrauterine d...Selective fetal growth restriction (sFGR) is a severe condition that complicates 10% to 15% of all monochorionic diamniotic (MCDA) twin pregnancies. Pregnancies complicated with sFGR are at high risk of intrauterine demise or adverse perinatal outcome for the twins. Three clinical types have been described according to the umbilical artery (UA) Doppler pattern observed in the smaller twin: type I, when the UA Doppler is normal;type II, when there is persistent absent or reversed end-diastolic blood flow in the UA Doppler;and type III, when there is intermittent absent and/or reversed end-diastolic blood flow in the UA Doppler. Clinical evolution and management options mainly depend on the type of sFGR. Type I is usually associated with a good prognosis and is managed conservatively. There is no consensus on the management of types II and III, but in earlier and more severe presentations, fetal interventions such as selective laser photocoagulation of placental anastomoses or selective fetal cord occlusion of the smaller twin may be considered. This review aims to provide updated information about the diagnosis, evaluation, follow-up, and management of sFGR in MCDA twin pregnancies.展开更多
One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental an...One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.展开更多
BACKGROUND The incidence of multiple pregnancies has increased worldwide recently and women with a twin pregnancy are at higher risk of adverse outcomes compared with women with a singleton pregnancy.It is important t...BACKGROUND The incidence of multiple pregnancies has increased worldwide recently and women with a twin pregnancy are at higher risk of adverse outcomes compared with women with a singleton pregnancy.It is important to understand the risk factors for adverse fetal outcomes in twin pregnancy in order to guide clinical management.AIM To identify the independent risk factors,including maternal personal and family medical histories and first trimester ultrasound screening findings,for adverse fetal outcomes of twin pregnancy before 28 weeks of gestation.METHODS The data of 126 twin pregnancies in our hospital,including pregnancy outcomes,first trimester ultrasound screening findings and maternal medical history,were retrospectively collected.Twenty-nine women with adverse outcomes were included in the abnormal group and the remaining 97 women were included in the control group.RESULTS Patients in the abnormal group were more likely to be monochorionic diamniotic(13/29 vs 20/97,P=0.009),with a higher mean pulsatility index(PI,1.57±0.55 vs 1.28±0.42,P=0.003;cutoff value:1.393)or a higher mean resistance index(0.71±0.11 vs 0.65±0.11,P=0.008;cutoff value:0.683)or early diastolic notch of bilateral uterine arteries(UtAs,10/29 vs 15/97,P=0.024)or with abnormal ultrasound findings(13/29 vs 2/97,P<0.001),compared with the control group.Monochorionic diamnioticity,higher mean PI of bilateral UtAs and abnormal ultrasound findings during first trimester screening were independent risk factors for adverse fetal outcomes(P<0.05).CONCLUSION First trimester ultrasound screening for twin pregnancy identifies independent risk factors and is useful for the prediction of fetal outcomes.展开更多
Twins are more likely to have congenital anomalies than singletons. Omphalocele is still a life-threatening congenital abnormality that requires adequate antenatal diagnosis and early treatment. A 31-year-old woman pr...Twins are more likely to have congenital anomalies than singletons. Omphalocele is still a life-threatening congenital abnormality that requires adequate antenatal diagnosis and early treatment. A 31-year-old woman presented with labor pains in the eighth pregnancy month. There was a clear, watery discharge from the birth canal 4 hours before admission. She was previously diagnosed with twins, with one cotwin having suffered omphalocele through a 6-month-ultrasound examination. At admission, the condition was diagnosed as monochorionic-diamniotic twins at 32 - 33 weeks in the 2nd stage of labor: the first baby cephalic presentation;second breech presentation with omphalocele. She vaginally gave birth to twin infants, with those having Apgar 5’ of 6/7, respectively. Both infants were admitted to the intensive care unit and under treatment.展开更多
文摘Selective fetal growth restriction (sFGR) is a severe condition that complicates 10% to 15% of all monochorionic diamniotic (MCDA) twin pregnancies. Pregnancies complicated with sFGR are at high risk of intrauterine demise or adverse perinatal outcome for the twins. Three clinical types have been described according to the umbilical artery (UA) Doppler pattern observed in the smaller twin: type I, when the UA Doppler is normal;type II, when there is persistent absent or reversed end-diastolic blood flow in the UA Doppler;and type III, when there is intermittent absent and/or reversed end-diastolic blood flow in the UA Doppler. Clinical evolution and management options mainly depend on the type of sFGR. Type I is usually associated with a good prognosis and is managed conservatively. There is no consensus on the management of types II and III, but in earlier and more severe presentations, fetal interventions such as selective laser photocoagulation of placental anastomoses or selective fetal cord occlusion of the smaller twin may be considered. This review aims to provide updated information about the diagnosis, evaluation, follow-up, and management of sFGR in MCDA twin pregnancies.
文摘One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.
基金Supported by Natural Science Foundation of Shanghai,China,No.22ZR1458200Medical Ph.D Innovative Talent Base Project of Changning District,Shanghai,China,No.RCJD2021B09Key Specialty of Changning District,Shanghai,China,No.20231004.
文摘BACKGROUND The incidence of multiple pregnancies has increased worldwide recently and women with a twin pregnancy are at higher risk of adverse outcomes compared with women with a singleton pregnancy.It is important to understand the risk factors for adverse fetal outcomes in twin pregnancy in order to guide clinical management.AIM To identify the independent risk factors,including maternal personal and family medical histories and first trimester ultrasound screening findings,for adverse fetal outcomes of twin pregnancy before 28 weeks of gestation.METHODS The data of 126 twin pregnancies in our hospital,including pregnancy outcomes,first trimester ultrasound screening findings and maternal medical history,were retrospectively collected.Twenty-nine women with adverse outcomes were included in the abnormal group and the remaining 97 women were included in the control group.RESULTS Patients in the abnormal group were more likely to be monochorionic diamniotic(13/29 vs 20/97,P=0.009),with a higher mean pulsatility index(PI,1.57±0.55 vs 1.28±0.42,P=0.003;cutoff value:1.393)or a higher mean resistance index(0.71±0.11 vs 0.65±0.11,P=0.008;cutoff value:0.683)or early diastolic notch of bilateral uterine arteries(UtAs,10/29 vs 15/97,P=0.024)or with abnormal ultrasound findings(13/29 vs 2/97,P<0.001),compared with the control group.Monochorionic diamnioticity,higher mean PI of bilateral UtAs and abnormal ultrasound findings during first trimester screening were independent risk factors for adverse fetal outcomes(P<0.05).CONCLUSION First trimester ultrasound screening for twin pregnancy identifies independent risk factors and is useful for the prediction of fetal outcomes.
文摘Twins are more likely to have congenital anomalies than singletons. Omphalocele is still a life-threatening congenital abnormality that requires adequate antenatal diagnosis and early treatment. A 31-year-old woman presented with labor pains in the eighth pregnancy month. There was a clear, watery discharge from the birth canal 4 hours before admission. She was previously diagnosed with twins, with one cotwin having suffered omphalocele through a 6-month-ultrasound examination. At admission, the condition was diagnosed as monochorionic-diamniotic twins at 32 - 33 weeks in the 2nd stage of labor: the first baby cephalic presentation;second breech presentation with omphalocele. She vaginally gave birth to twin infants, with those having Apgar 5’ of 6/7, respectively. Both infants were admitted to the intensive care unit and under treatment.
