Perinatal outcome of monochorionic twins with selective intrauterine growth restriction and different types of umbilical artery Doppler under expectant management.
OBJECTIVE
To evaluate the prognosis of monochorionic twins with selective intrauterine growth restriction (sIUGR), classified according to the type of umbilical artery Doppler, under expectant management.


METHODS
The outcome of 81 cases with isolated sIUGR was evaluated according to a classification based on umbilical artery (UA) Doppler diastolic flow in the IUGR twin (I: present, II: constantly absent/reverse, III: intermittently absent/reverse). Selective feticide was not considered due to legal constraints. Perinatal outcomes included perinatal death and neurological outcome at 6 months of age.


RESULTS
From 81 cases with the diagnosis of sIUGR, twin-twin transfusion was diagnosed in 18 cases. This left 63 cases, of which 23 were classified as type I (36.5%), 27 as type II (42.9%) and 13 as type III (20.6%). Intrauterine death occurred in 4.3% (1), 29.6% (8) and 15.4% (2) among IUGR twins, and 4.3% (1), 22.2% (6) and 0.0% (0) among larger twins. Neonatal death occurred in 0.0% (0), 18.5% (5) and 0.0% (0) among IUGR twins, and 0.0% (0), 11.1% (3) and 23.0% (3) among larger twins. Neurological abnormalities at 6 months were found in 4.3% (1), 14.8% (4) and 23.1% (3) in smaller twins and 0.0% (0), 11.1% (3) and 38.5% (5) in larger twins, respectively. Intact survival at 6 months was recorded in 91% (21), 37% (10) and 61% (8) in smaller twins and 95% (22), 55% (15) and 38% (5) in larger twins, respectively.


CONCLUSIONS
The outcome in monochorionic twins with sIUGR and abnormal umbilical artery Doppler is poor under expectant management. Normal Doppler seems to be associated with a good prognosis.
Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Nakaku, Hamamatsu, Japan. keisui@sis.seirei.or.jp
Keisuke
K
Ishii
Takeshi
T
Murakoshi
Yuichiro
Y
Takahashi
Takashi
T
Shinno
Mitsuru
M
Matsushita
Hiroo
H
Naruse
Yuichi
Y
Torii
Masahiro
M
Sumie
Masahiko
M
Nakata
D002823:Chorion / Q000033:anatomy & histology; D004200:Diseases in Twins / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D014430:Twins, Monozygotic; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*