Growth discordance

Area of Science:

• Maternal-Fetal Medicine
• Perinatology
• Twin Pregnancy Research

Background:

• Poor fetal growth is a frequent complication in twin pregnancies, presenting unique management challenges.
• Assessing the risk of intrauterine demise versus the potential for intact postnatal survival is crucial for delivery decisions.
• Monochorionic twins face additional complexities due to shared circulation, where the health of one twin directly impacts the other.

Purpose of the Study:

• To highlight the challenges in managing growth-restricted twins, particularly monochorionic gestations.
• To emphasize the critical balance between intervention timing and the risk of adverse outcomes for both twins.
• To discuss the potential role of invasive fetal therapy in the pre-viable period for monochorionic twins.

Main Methods:

• Review of clinical management strategies for twin pregnancies with poor growth.
• Analysis of risks associated with intrauterine demise in growth-restricted twins.
• Consideration of shared placental circulation effects in monochorionic twins.

Main Results:

• The decision for early delivery hinges on the likelihood of both twins surviving postnatally without significant morbidity.
• In monochorionic twins, demise of a growth-restricted twin poses a severe risk of exsanguination and brain damage to the co-twin.
• The shared circulation in monochorionic twins necessitates a unified management approach, considering the interdependence of both fetuses.

Conclusions:

• Management of growth restriction in twin pregnancies requires a delicate balance to optimize outcomes for both fetuses.
• In monochorionic twins, the risk of demise of one twin can precipitate severe complications for the survivor.
• Invasive fetal therapy may be a viable option in the pre-viable period to safeguard the appropriately growing twin in complex monochorionic gestations.