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CME Credit Offered
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Abstract Award
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Poster Session 3

(716) Monochorionic Twins with Selective Fetal Growth Restriction: characteristics, course, management, and outcomes by type

Friday, January 31, 2025
10:30 AM – 12:30 PM  
Objective: To compare characteristics, Doppler course, and outcomes in Type I, II, and III selective fetal growth restriction (sFGR).

Study Design: Single-center retrospective review of monochorionic twins with sFGR from 6/2014 to 1/2024. Twin to Twin Transfusion Syndrome, high order multiples, and severe fetal anomalies were excluded. Type at diagnosis was assigned by Gratacos criteria. Doppler course (deterioration or improvement) was defined as progression of umbilical artery (UA) end diastolic flow patterns from best to worst: persistent forward intermittent forward, absent intermittent forward, absent, reversedpersistent absentpersistent reversed. Ultrasound characteristics at presentation, antenatal course, and obstetric outcomes were compared between groups via Kruskal-Wallis and Pearson Chi-Squared.

Results: Of 199 patients, 133 (67%) were Type I, 18 (9%) Type II, and 48 (24%) Type III. There was no difference in gestational age (GA) at diagnosis. The estimated fetal weight discordance was lowest in Type I and highest in Type II (p < 0.001). UA Doppler deterioration was frequent in all groups and occurred in 28.4% of Type 1, 76.9% of Type II, and 51.4% of Type III (P < 0.001).  UA Dopplers also improved in some Type II (15.4%) and Type III (25.7%, p=0.449). Management varied but was expectant for most (178/199, 89%) though 7 (4%) underwent laser (6/7 had Twin Anemia Polycythemia Sequence), 12 (6%) had selective reduction of the small fetus, and 2 (1%) terminated. Double survival was 89.6% in Type I, 25% in Type II, and 77.8% in Type III (p < 0.001). There was no difference in delivery GA between types, however, the majority of Type II were delivering a single fetus, and amongst all patients, those with 1 vs. 2 livebirths delivered later (36.1 [31.7-38.7] vs. 33.1 [30.9-34.3] weeks, p=0.002). (Table 1)

Conclusion: Doppler deterioration is common in all Types of sFGR. Types II and III can improve in some cases and can be successfully managed to achieve favorable delivery gestational ages, however double survival is significantly lower in Type II.