Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: a cross‐sectional international survey
Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: a cross‐sectional international survey
Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Design: Cross-sectional survey. Setting: International. Population: Clinicians involved in the management of MCDA twin pregnancies with sFGR. Methods: A structured, self-administered survey. Main Outcome Measures: Clinical practices and attitudes to diagnostic criteria and management strategies. Results: Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. Conclusions: There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management.
clinical trial, cord occlusion, definition, diagnosis, fetal growth restriction, feticide, fetoscopic laser surgery, intervention, intrauterine demise, morbidity, mortality, multiple, neonatal, pregnancy, prognosis, small for gestational age, stillbirth, surgery, survey
Prasad, Smriti
de2ab3ca-7c2e-4696-8b61-2184d05ca005
Khalil, Asma
81dc2f64-ca03-43e5-908f-2ee7344d215d
Kirkham, Jamie J.
70715e7a-3f65-43e5-970a-526311ee38e1
Vollmer, Brigitte
044f8b55-ba36-4fb2-8e7e-756ab77653ba
2 July 2024
Prasad, Smriti
de2ab3ca-7c2e-4696-8b61-2184d05ca005
Khalil, Asma
81dc2f64-ca03-43e5-908f-2ee7344d215d
Kirkham, Jamie J.
70715e7a-3f65-43e5-970a-526311ee38e1
Vollmer, Brigitte
044f8b55-ba36-4fb2-8e7e-756ab77653ba
Prasad, Smriti, Khalil, Asma and Kirkham, Jamie J.
,
FERN Study Team
(2024)
Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: a cross‐sectional international survey.
BJOG: An International Journal of Obstetrics & Gynaecology.
(doi:10.1111/1471-0528.17891).
Abstract
Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Design: Cross-sectional survey. Setting: International. Population: Clinicians involved in the management of MCDA twin pregnancies with sFGR. Methods: A structured, self-administered survey. Main Outcome Measures: Clinical practices and attitudes to diagnostic criteria and management strategies. Results: Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. Conclusions: There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management.
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BJOG - 2024 - Prasad - Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies A
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Accepted/In Press date: 2 June 2024
e-pub ahead of print date: 2 July 2024
Published date: 2 July 2024
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© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Keywords:
clinical trial, cord occlusion, definition, diagnosis, fetal growth restriction, feticide, fetoscopic laser surgery, intervention, intrauterine demise, morbidity, mortality, multiple, neonatal, pregnancy, prognosis, small for gestational age, stillbirth, surgery, survey
Identifiers
Local EPrints ID: 491731
URI: http://eprints.soton.ac.uk/id/eprint/491731
ISSN: 1470-0328
PURE UUID: 8daee3c3-c188-4f39-972d-305270aec30d
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Date deposited: 03 Jul 2024 16:56
Last modified: 18 Jul 2024 01:42
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Contributors
Author:
Smriti Prasad
Author:
Asma Khalil
Author:
Jamie J. Kirkham
Corporate Author: FERN Study Team
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