Fetal growth restriction in twins

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Twin Pregnancy Research

Background:

• Twin pregnancies face higher risks of fetal growth restriction (FGR), preterm birth, and perinatal loss.
• Managing FGR in multiple pregnancies, especially when only one twin is affected, is complex.
• Selective FGR in monochorionic (MC) twins has distinct pathophysiology from dichorionic (DC) pregnancies, necessitating understanding of placental structure and fetal circulations.

Purpose of the Study:

• To review current evidence on the diagnosis, classification, and management of selective FGR (sFGR) in MC twins.
• To highlight the distinct pathophysiological processes of sFGR in MC twins compared to DC pregnancies.
• To discuss potential future research directions for improving sFGR management.

Main Methods:

• Comprehensive literature review of diagnostic and management strategies for sFGR in MC twins.
• Analysis of evidence regarding fetal therapies, including selective fetal reduction and laser photocoagulation.
• Synthesis of current understanding of MC placental anatomy and interdependent fetal circulations.

Main Results:

• sFGR in MC twins presents unique diagnostic and management challenges compared to FGR in DC twins.
• Fetal therapies like selective fetal reduction and laser photocoagulation offer antenatal management options for sFGR.
• Understanding MC placental structure is crucial for effective management of sFGR.

Conclusions:

• Effective management of sFGR in MC twins requires specialized knowledge of placental vasculature and fetal interdependence.
• Continued research into diagnostic tools and therapeutic interventions is essential for improving outcomes in sFGR.
• Future research should focus on refining treatment strategies and understanding long-term outcomes for affected twins.