EP07.11: Improvement of fetal weight after nutrition intervention on a case of selective fetal growth restriction of a monochorionic twin pregnancy

Abstract

A 37 year-old pregnant woman with monochorionic diamniotic twins presented at 12 weeks a velamentous cord insertion of one fetus (fetus A) with no other fetal discrepancy. From 16 to 23 week scans no major fetal discrepancy on fetal weigh, amniotic fluid, bladder size and placental-fetal Doppler PI was observed. From 24 to 28 weeks discrepancy of fetal weigh was observed on the fetus A, presenting intra uterine growth restriction (IUGR), without change on amniotic fluid our bladder size. Umbilical Doppler of fetus A showed intermittent normal to zero end diastolic flow on umbilical artery with normal middle cerebral artery flow and velocity. Laser ablation was offered as a possible treatment but the patient declined faced to risk of premature labour. Hyper caloric supplement diet was initiated as a patient when the fetus reached the 1st centile at 28 weeks of gestation. On the following exams the fetal A weigh curve shifted up from 3rd centile at 29 weeks to 15th centile at 35 weeks. Caesarean section was performed at 37 weeks presenting two female newborns weighting 2235 g on fetus A and 2680 on fetus B. We believe that some benefit with nutritional intervention may improve fetal outcome of twin fetus with selective IUGR.