The changing Doppler patterns and perinatal outcomes of monochorionic diamniotic twins with selective fetal growth restriction
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Luyao Li
,
Pengbo Yuan
Abstract
Objectives
To investigate the clinical outcomes and Doppler patterns changes in monochorionic diamniotic (MCDA) twins with selective fetal growth restriction (sFGR).
Methods
We retrospectively analyzed 362 sFGR cases from January 2010 to May 2016 at a single tertiary referral center. The Doppler waveforms of umbilical artery end-diastolic flow were collected, and all neonates were subjected to an early neonatal brain scan.
Results
A total of 66/100 (66 %) type I cases were stable, whereas 25/100 (25 %) cases changed to type II and 9/100 (9 %) changed to sFGR complicated twin-twin transfusion syndrome (TTTS). A total of 48.9 % (22/45) sFGR cases were complicated with polyhydramnios and 30.4 % (7/23) sFGR cases were complicated with oligohydramnios, both of which were progressed to sFGR with TTTS. Mild cerebral injury was significantly associated with Doppler flow abnormalities, earlier gestational age at delivery and type of sFGR diagnosis. Severe cerebral injury was significantly associated with gestational age at delivery (31.6 vs. 34.1, p=0.002) and larger birthweight discordance (43.9 vs. 29.3 %, p=0.011).
Conclusions
Doppler patterns in sFGR can gradually change, with important consequences with regard to management and outcomes. Along with abnormal Doppler findings, earlier occurrence of sFGR and delivery are associated with subsequent neonatal cerebral injury.
Funding source: Natural Science Foundation of Beijing Municipality
Award Identifier / Grant number: 7222219
Funding source: National Key Research and Development Program of China
Award Identifier / Grant number: 2018YFC1002900
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Research ethics: The study was approved by the Ethics Committee of Peking University Third Hospital (Number: M2016199).
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Author contributions: Luyao Li and Xueju Wang contribute equally to the manuscript. All authors contributed to the study conception and design. Study design and project development were performed by Yuan Wei and Yangyu Zhao. Material preparation, data collection, and analysis were performed by Luyao Li, Xueju Wang, and Pengbo Yuan. Data analysis check and consultation were performed by Xueju Wang. The first draft of the manuscript was written by Luyao Li and Xueju Wang and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Competing interests: The authors state no conflict of interest.
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Research funding: This study was supported by grants from the Natural Science Foundation of Beijing Municipality (7222219) and National Key Research and Development Program of China (2018YFC1002900).
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Data availability: The raw data can be obtained on request from the corresponding author.
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Articles in the same Issue
- Frontmatter
- Corner of Academy
- The outcome of reduced and non-reduced triplet pregnancies managed in a tertiary hospital during a 15-year-period – a retrospective cohort study
- Original Articles – Obstetrics
- Parental refusal of prenatal screening for aneuploidies
- Analysis of maternal mortality in Berlin, Germany – discrepancy between reported maternal mortality and comprehensive death certificate exploration
- Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia
- Incidence and first trimester risk factors of stillbirth in Indonesia
- Correlation of fetal heart rate dynamics to inflammatory markers and brain-derived neurotrophic factor during pregnancy
- Preliminary assessment of the Healthy Early Life Moments (HELMS) webinars in empowering Developmental Origins of Health and Disease (DOHaD) concept among healthcare professionals – a pragmatic serial cross-sectional study
- Original Articles – Fetus
- The changing Doppler patterns and perinatal outcomes of monochorionic diamniotic twins with selective fetal growth restriction
- Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study
- Original Articles – Neonates
- Prediction of bronchopulmonary dysplasia by the chest radiographic thoracic area on day one in infants with exomphalos
- Impact of birth weight to placental weight ratio and other perinatal risk factors on left ventricular dimensions in newborns: a prospective cohort analysis
- Changes in regional tissue oxygen saturation values during the first week of life in stable preterm infants
- Letters to the Editor
- Optimal closure of the uterus during cesarean section: beyond the two layers
- Reply to: “Optimal closure of the uterus during cesarean section: beyond the two layers” commenting on “The effect of uterine closure technique on cesarean scar niche development after multiple cesarean deliveries”
Articles in the same Issue
- Frontmatter
- Corner of Academy
- The outcome of reduced and non-reduced triplet pregnancies managed in a tertiary hospital during a 15-year-period – a retrospective cohort study
- Original Articles – Obstetrics
- Parental refusal of prenatal screening for aneuploidies
- Analysis of maternal mortality in Berlin, Germany – discrepancy between reported maternal mortality and comprehensive death certificate exploration
- Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia
- Incidence and first trimester risk factors of stillbirth in Indonesia
- Correlation of fetal heart rate dynamics to inflammatory markers and brain-derived neurotrophic factor during pregnancy
- Preliminary assessment of the Healthy Early Life Moments (HELMS) webinars in empowering Developmental Origins of Health and Disease (DOHaD) concept among healthcare professionals – a pragmatic serial cross-sectional study
- Original Articles – Fetus
- The changing Doppler patterns and perinatal outcomes of monochorionic diamniotic twins with selective fetal growth restriction
- Effects of umbilical vein flow on midbrain growth and cortical development in late onset fetal growth restricted fetuses: a prospective cross-sectional study
- Original Articles – Neonates
- Prediction of bronchopulmonary dysplasia by the chest radiographic thoracic area on day one in infants with exomphalos
- Impact of birth weight to placental weight ratio and other perinatal risk factors on left ventricular dimensions in newborns: a prospective cohort analysis
- Changes in regional tissue oxygen saturation values during the first week of life in stable preterm infants
- Letters to the Editor
- Optimal closure of the uterus during cesarean section: beyond the two layers
- Reply to: “Optimal closure of the uterus during cesarean section: beyond the two layers” commenting on “The effect of uterine closure technique on cesarean scar niche development after multiple cesarean deliveries”
