Mazer Zumaeta Alicia, Gil María Mar, Rodríguez-Fernández Miguel, Carretero Pilar, Ochoa José Hector, Casanova María Cristina, Molina Francisca Sonia
Department of Obstetrics and Gynecology, Hospital Universitario Clínico San Cecilio, Granada 18016, Spain.
Department of Obstetrics and Gynecology, Hospital Materno Provincial Dr. Raúl Felipe Lucini, Córdoba 5000, Argentina.
Matern Fetal Med. 2022 Sep 21;4(4):268-275. doi: 10.1097/FM9.0000000000000171. eCollection 2022 Oct.
Selective fetal growth restriction (sFGR) is a severe condition that complicates 10% to 15% of all monochorionic diamniotic (MCDA) twin pregnancies. Pregnancies complicated with sFGR are at high risk of intrauterine demise or adverse perinatal outcome for the twins. Three clinical types have been described according to the umbilical artery (UA) Doppler pattern observed in the smaller twin: type I, when the UA Doppler is normal; type II, when there is persistent absent or reversed end-diastolic blood flow in the UA Doppler; and type III, when there is intermittent absent and/or reversed end-diastolic blood flow in the UA Doppler. Clinical evolution and management options mainly depend on the type of sFGR. Type I is usually associated with a good prognosis and is managed conservatively. There is no consensus on the management of types II and III, but in earlier and more severe presentations, fetal interventions such as selective laser photocoagulation of placental anastomoses or selective fetal cord occlusion of the smaller twin may be considered. This review aims to provide updated information about the diagnosis, evaluation, follow-up, and management of sFGR in MCDA twin pregnancies.
选择性胎儿生长受限（sFGR）是一种严重情况，在所有单绒毛膜双羊膜囊（MCDA）双胎妊娠中，有10%至15%会出现这种并发症。合并sFGR的妊娠，双胎发生宫内死亡或不良围产期结局的风险很高。根据在较小胎儿中观察到的脐动脉（UA）多普勒血流模式，已描述了三种临床类型：I型，UA多普勒正常；II型，UA多普勒存在持续的舒张末期血流缺失或反向；III型，UA多普勒存在间歇性舒张末期血流缺失和/或反向。临床进展和管理方案主要取决于sFGR的类型。I型通常预后良好，采用保守治疗。对于II型和III型的管理尚无共识，但在病情出现较早且较严重的情况下，可考虑采取胎儿干预措施，如对胎盘吻合支进行选择性激光光凝或对较小胎儿进行选择性胎儿脐带闭塞。本综述旨在提供有关MCDA双胎妊娠中sFGR的诊断、评估、随访和管理的最新信息。
