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Open AccessArticle

Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome

1
Fetal Medicine Unit, St George’s University Hospitals, Blackshaw Road, London SW17 0QT, UK
2
3rd Department of Obstetrics Gynaecology and Feto-Maternal Medicine, University of Athens Medical School, Attikon Hospital & Gynecology Obstetrics and Perinatal Medicine Unit, Evgenideio Hospital, 11528 Athens, Greece
3
Division of Obstetrics and Feto-Maternal Medicine, Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Vienna, Austria
4
Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara 06800, Turkey
5
Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK
*
Author to whom correspondence should be addressed.
The authors N. A. and P. P. have contributed equally to this study.
J. Clin. Med. 2020, 9(5), 1404; https://doi.org/10.3390/jcm9051404
Received: 25 March 2020 / Revised: 22 April 2020 / Accepted: 28 April 2020 / Published: 9 May 2020
(This article belongs to the Special Issue Improving Perinatal Outcomes in Twin and Multiple Pregnancy)
This study aims to evaluate the natural history, disease progression, and outcomes in dichorionic twins with selective fetal growth restriction (sFGR) according to different diagnostic criteria and time of onset. Dichorionic twins seen from the first trimester were included. sFGR was classified according to the Delphi consensus, and was compared to the outcomes of those classified by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) diagnostic criteria. Early sFGR occurred before 32-weeks, and late sFGR after 32-weeks. Disease progression, neonatal outcomes such as gestation at delivery, birthweight, neonatal unit (NNU) admission, and morbidities were compared. One-hundred twenty-three of 1053 dichorionic twins had sFGR, where 8.4% were classified as early sFGR, and 3.3% were late sFGR. Disease progression was seen in 36%, with a longer progression time (5 vs. 1 week) and higher progression rate (40% vs. 26%) in early sFGR. Perinatal death was significantly higher in the sFGR than the non-sFGR group (24 vs. 16 per 1000 births, p = 0.018), and those with early sFGR had more NNU admissions than late sFGR (p = 0.005). The ISUOG diagnostic criteria yielded a higher number of sFGR than the Delphi criteria, but similar outcomes. sFGR have worse perinatal outcomes, with early onset being more prevalent. Use of the Delphi diagnostic criteria can reduce over-diagnosis of sFGR and avoid unnecessary intervention. View Full-Text
Keywords: DCDA twins; selective fetal growth restriction; morbidity and mortality; natural history; diagnostic criteria DCDA twins; selective fetal growth restriction; morbidity and mortality; natural history; diagnostic criteria
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MDPI and ACS Style

Antonakopoulos, N.; Pateisky, P.; Liu, B.; Kalafat, E.; Thilaganathan, B.; Khalil, A. Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome. J. Clin. Med. 2020, 9, 1404. https://doi.org/10.3390/jcm9051404

AMA Style

Antonakopoulos N, Pateisky P, Liu B, Kalafat E, Thilaganathan B, Khalil A. Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome. Journal of Clinical Medicine. 2020; 9(5):1404. https://doi.org/10.3390/jcm9051404

Chicago/Turabian Style

Antonakopoulos, Nikolaos; Pateisky, Petra; Liu, Becky; Kalafat, Erkan; Thilaganathan, Baskaran; Khalil, Asma. 2020. "Selective Fetal Growth Restriction in Dichorionic Twin Pregnancies: Diagnosis, Natural History, and Perinatal Outcome" J. Clin. Med. 9, no. 5: 1404. https://doi.org/10.3390/jcm9051404

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