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Fetal growth in multifetal gestation
1Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Clinical Obstetrics and Gynecology
|January 16, 1998
Summary
Multiple fetuses increase abnormal fetal growth risks. Early detection of growth discordancy via ultrasound and genetic analysis guides management for improved outcomes in twin pregnancies.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Diagnostic Ultrasound
Background:
- Multiple gestations are associated with higher rates of fetal growth abnormalities.
- Birth weight discordancy definitions vary, typically ranging from 15% to 40%.
Purpose of the Study:
- To outline diagnostic criteria and management strategies for fetal growth discordancy in multiple gestations.
- To emphasize the role of ultrasound and genetic analysis in identifying and managing discordant fetal growth.
Main Methods:
- Utilized ultrasound biometry (CRL, GSD, BPD, HC, AC, femur length) for early detection of discordancy.
- Incorporated Doppler velocimetry of umbilical arteries to enhance diagnostic accuracy.
- Recommended karyotyping and chromosomal analysis for suspected genetic contributions.
Main Results:
- Abdominal circumference (AC) and estimated fetal weight (SEFW) are key sonographic predictors of twin growth discordancy.
- Discordant Doppler velocimetry improves the diagnosis of twin discordancy.
- Twin-twin transfusion syndrome is a consideration in monochorionic gestations with growth discordancy.
Conclusions:
- Early identification of fetal growth discordancy necessitates genetic counseling and work-up.
- Monitoring protocols differ for concordant versus discordant twins, with closer surveillance for discordant cases.
- Management decisions, including conservative approaches, should prioritize fetal well-being, especially in premature gestations.