Department of Pediatrics, Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
Department of Obstetrics, Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Prenat Diagn. 2022 Aug;42(9):1094-1110. doi: 10.1002/pd.6206. Epub 2022 Jul 17.
This systematic review aims to assess the gestational age at birth and perinatal outcome [intrauterine demise (IUD), neonatal mortality and severe cerebral injury] in monochorionic twins with selective fetal growth restriction (sFGR), according to Gratacós classification based on umbilical artery Doppler flow patterns in the smaller twin. Seventeen articles were included. Gestational age at birth varied from 33.0 to 36.0 weeks in type I, 27.6-32.4 weeks in type II, and 28.3-33.8 weeks in type III. IUD rate differed from 0%-4% in type I to 0%-40% in type II and 0%-23% in type III. Neonatal mortality rate was between 0%-10% in type I, 0%-38% in type II, and 0%-17% in type III. Cerebral injury was present in 0%-2% of type I, 2%-30% of type II and 0%-33% of type III cases. The timing of delivery in sFGR varied substantially among studies, particularly in type II and III. The quality of evidence was moderate due to heterogenous study populations with varying definitions of sFGR and perinatal outcome parameters, as well as a lack of consensus on the use of the Gratacós classification, leading to substantial incomparability. Our review identifies the urgent need for uniform antenatal diagnostic criteria and definitions of outcome parameters.
本系统评价旨在评估根据 Gratacós 分类，根据较小胎儿的脐动脉多普勒血流模式，根据 Gratacós 分类，单绒毛膜双胞胎中选择性胎儿生长受限（sFGR）的胎龄和围产期结局（宫内死亡（IUD）、新生儿死亡率和严重脑损伤）。纳入了 17 篇文章。I 型的出生胎龄为 33.0 至 36.0 周，II 型为 27.6-32.4 周，III 型为 28.3-33.8 周。IUD 率在 I 型为 0%-4%，在 II 型为 0%-40%，在 III 型为 0%-23%。新生儿死亡率在 I 型为 0%-10%，在 II 型为 0%-38%，在 III 型为 0%-17%。脑损伤在 I 型为 0%-2%，在 II 型为 2%-30%，在 III 型为 0%-33%。sFGR 的分娩时机在研究中差异很大，特别是在 II 型和 III 型中。由于 sFGR 和围产期结局参数的定义存在异质性研究人群，以及对 Gratacós 分类的使用缺乏共识，导致可比性大大降低，证据质量为中等。我们的综述确定了迫切需要统一的产前诊断标准和结局参数的定义。
