Clinical Outcome of Monochorionic Diamniotic Twins with Intrauterine Growth Restriction

Tian Qiu; Weiwei Cheng; Yan Chen; Yuna Guo; Hong Shen; Liang Xu

doi:10.1055/s-0042-1754394

Clinical Outcome of Monochorionic Diamniotic Twins with Intrauterine Growth Restriction

Am J Perinatol. 2023 Dec 28. doi: 10.1055/s-0042-1754394. Online ahead of print.

Authors

Tian Qiu¹, Weiwei Cheng², Yan Chen², Yuna Guo², Hong Shen², Liang Xu²

Affiliations

¹ Department of Obstetrics and Gynecology, The Sixth People's Hospital of Shanghai Affiliated to Shanghai Jiao Tong University, Shanghai, People's Republic of China.
² Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, People's Republic of China.

PMID: 38154467
DOI: 10.1055/s-0042-1754394

Abstract

Objective: This study investigated the clinical outcome of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR).

Study design: International Peace Maternal and Child Health Hospital of Shanghai ultrasound database was investigated to identify all MCDA delivered from January 2013 to December 2017. After identifying 43 pairs of MCDA twins with sIUGR and 282 pairs of normal MCDA twins, we compared clinical outcomes between the two groups.

Results: Compared with normal twins, sIUGR fetuses had significantly shorter gestational age at delivery, smaller average birth weight of both twins, more significant intertwin difference in birth weight, lower Apgar scores, and higher intrauterine fetal demise (IUFD) rate, and smaller placental weight. The rate of abnormal umbilical cord insertions and abnormal blood flow in the ductus venosus (DV) and middle cerebral artery (MCA) is significantly higher in the sIUGR group. In addition, the subtype analysis of sIUGR groups indicated the poorest outcomes in type II with no significant difference between type I and III.

Conclusion: MCDA twins with sIUGR generally exhibited limited clinical outcomes than normal MCDA twins. These limitations are mainly associated with abnormal umbilical cord insertions and blood flow in the DV and MCA. Clinical outcomes differed among the three types of sIUGR, with type II having the worst prognosis and the highest IUFD rate.

Key points: · sIUGR generally exhibited limited clinical outcomes than normal MCDA twins.. · These limitations are mainly associated with blood flow of the DV and MCA.. · sIUGR with type II has the worst prognosis and the highest IUFD rate..

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).