Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland.
Centre of Postgraduate Medical Education, 1st Obstetrics and Gynecology Clinic, Warsaw, Poland.
J Mother Child. 2021 Jul 6;24(4):24-30. doi: 10.34763/jmotherandchild.20202404.d-20-00016.
Foetal growth restriction (FGR) complicates about 25-47% of twin pregnancies. One or both foetuses can be restricted. Pregnancies with discordant growth of foetuses are associated with a sevenfold increased risk of neonatal morbidity.
This is a narrative or traditional literature review. A literature search was performed to present a comprehensive, critical and objective analysis of the current knowledge on growth restriction in twin pregnancies.
The definitions of FGR in twin pregnancies and selective FGR (sFGR) differ between international societies. In 2019, the Delphi procedure aimed to unify the definitions of sFGR in twin pregnancies. Several growth charts for twins have been published. However, most societies recommend singleton growth charts as better in detecting hypoxic complications of FGR in twin pregnancies. Discordant growth in twins results from placental insufficiency, congenital anomalies, chromosomal aberrations and TORCH infections.
Definitions and management of sFGR depend on chorionicity. The management aims to protect the properly growing foetus from ischemic complications or in utero death. In most cases, expectant management, strict surveillance and preterm labour are the methods of choice. Due to the co-existence of properly growing and small foetuses in one uterus, determining the appropriate time for delivery is challenging. In the case of preterm labour, even late preterm, antenatal corticosteroid therapy (ACT) in FGR twin pregnancies is beneficial because it decreases neonatal morbidity.
胎儿生长受限（FGR）在双胎妊娠中约占 25-47%。一个或两个胎儿都可能受限。胎儿生长不一致的妊娠与新生儿发病率增加七倍相关。
这是一篇叙述性或传统的文献综述。进行了文献检索，对双胎妊娠中生长受限的当前知识进行了全面、批判性和客观的分析。
国际社会对双胎妊娠中 FGR 和选择性胎儿生长受限（sFGR）的定义不同。2019 年，德尔菲程序旨在统一双胎妊娠中 sFGR 的定义。已经发表了几份双胞胎生长图表。然而，大多数协会建议使用单胎生长图表，因为它们更能检测出双胎妊娠中 FGR 的缺氧并发症。双胞胎的生长不一致是由于胎盘功能不全、先天性异常、染色体异常和 TORCH 感染引起的。
sFGR 的定义和管理取决于绒毛膜性。管理旨在保护正常生长的胎儿免受缺血性并发症或宫内死亡的影响。在大多数情况下，期待治疗、严格监测和早产是首选方法。由于在一个子宫中同时存在正常生长和小胎儿，因此确定适当的分娩时间具有挑战性。在早产的情况下，即使是晚期早产，FGR 双胎妊娠中的产前皮质激素治疗（ACT）也是有益的，因为它可以降低新生儿发病率。
