Type II and III Selective Fetal Growth Restriction: Perinatal Outcomes of Expectant Management and Laser Ablation of Placental Vessels

Mariana Yumi Miyadahira,Maria De Lourdes Brizot,Mário Henrique Burlacchini De Carvalho,Sckarlet Ernandes Biancolin,Rita De Cássia Alam Machado,Vera Lúcia Jornada Krebs,Rossana Pulcineli Vieira Francisco,Cleisson Fábio Andrioli Peralta

doi:10.6061/clinics/2018/e210

Abstract

OBJECTIVES:To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV).METHODS:Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate.RESULTS:The smaller fetus presented an absent/reversed “a” wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively.CONCLUSION:LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.

Highlights

Selective fetal growth restriction complicates 12-25% of monochorionic-diamniotic (MCDA) twin pregnancies [1]. sFGR is defined as an estimated fetal weight (EFW) below the 10th percentile for at least one twin and an EFW discrepancy between the twins X25% [2]
The smaller twin presented with absent/reversed ‘‘a’’ wave in the ductus venosus (arAWDV) in all the cases that underwent laser ablation of placental vessels (LAPV), whereas none of the fetuses in the expectant management group presented this finding at diagnosis
We described the perinatal outcomes of LAPV and expectant management for MCDA twin pregnancies with type II and III sFGR

Summary

Introduction

Selective fetal growth restriction (sFGR) complicates 12-25% of monochorionic-diamniotic (MCDA) twin pregnancies [1]. sFGR is defined as an estimated fetal weight (EFW) below the 10th percentile for at least one twin and an EFW discrepancy between the twins X25% [2]. Selective fetal growth restriction (sFGR) complicates 12-25% of monochorionic-diamniotic (MCDA) twin pregnancies [1]. SFGR is defined as an estimated fetal weight (EFW) below the 10th percentile for at least one twin and an EFW discrepancy between the twins X25% [2]. The etiology of this condition is not completely understood, unequal placental sharing combined with different types of placental anastomosis between the twins appears to play a key role in the clinical manifestations and outcomes [1,3,4,5]. Received for publication on June 1, 2017.

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