Cord Occlusion in Monochorionic Twins with Early Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler: A Consecutive Series of 90 Cases.
OBJECTIVE
To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III).


METHODS
We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow. All cases presented at least one of the following severity criteria: gestational age (GA) <22 weeks, inter-twin estimated weight discordance >35%, reversed end-diastolic umbilical artery flow or ductus venosus pulsatility index >95th centile. We prospectively recorded pregnancy course and perinatal outcome.


RESULTS
Median GA at surgery was 20.6 weeks and mean duration 22.4 min. Miscarriage (<24 weeks) occurred in 3.3% (3/90) and preterm delivery <32 weeks in 7.1% (6/84) of continuing pregnancies. GA at delivery was 36.4 weeks and neonatal survival of the larger twin was achieved in 93.3%.


CONCLUSIONS
In a consecutive series studied by an experienced team, CO in monochorionic twins with severe sIUGR type II or III was associated with delivery >32 weeks in 92.9% and neonatal survival of the normal twin in 93.3% of pregnancies.
Maternal-Fetal Unit, Hospital Clx00ED;nico de Chile, University of Chile, Santiago, Chile.
Mauro
M
Parra-Cordero
Mar
M
Bennasar
José María
JM
Martínez
Elisenda
E
Eixarch
Ximena
X
Torres
Eduard
E
Gratacós
D001724:Birth Weight; D004200:Diseases in Twins / Q000601:surgery*; D005260:Female; D005317:Fetal Growth Retardation / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D060205:Therapeutic Occlusion; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000601:surgery*; D014470:Umbilical Cord / Q000473:pathology / Q000601:surgery*