Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction.

Van Mieghem, T; Lewi, L; Slaghekke, F; Lopriore, E; Yinon, Y; Raio, L.; Baud, D; DeKoninck, P; Melamed, N; Huszti, E; Sun, L; Shinar, S (2022). Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction. Ultrasound in obstetrics & gynecology, 59(6), pp. 756-762. Wiley 10.1002/uog.24896

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OBJECTIVE

Monochorionic diamniotic (MCDA) twin complicated by type III selective fetal growth restriction (sFGR) are at high risk of fetal death. Our aim was to identify predictors of fetal death.

METHODS

We performed an international multicenter retrospective cohort study. Type III sFGR was defined as fetal growth of one twin below the 10th percentile and intertwin growth difference of 25% or more, in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were longitudinally recorded throughout gestation and assessed in uni- and multivariable using logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis.

RESULTS

Three-hundred and eight twin pregnancies (616 fetuses) were included in the analysis. In 273 pregnancies (88.6%) both twins were liveborn, whereas in 35 pregnancies there was either a single (n=19; 6.2%) or a double fetal death (n=16; 5.2%). Earlier gestational age at diagnosis of type III sFGR, oligohydramnios of the smaller twin and deterioration of umbilical artery Doppler flow were associated with an increased risk of fetal death. Neither parameter identified in the univariable analysis maintained statistical significance in multivariable analysis. The CART model allowed to identify three risk groups: a low risk group (risk of fetal death 6.8%) where the umbilical artery Doppler did not deteriorate, an intermediate risk group (risk of fetal death 16.3%) where the umbilical artery Doppler deteriorated but the diagnosis of sIUGR was first made after 16+5 weeks' gestation and a high-risk group (risk of fetal death 79%) where the umbilical artery Doppler deteriorated and gestational age at diagnosis was less than 16+5 weeks' gestation.

CONCLUSIONS

Type III sFGR is associated with a high risk of fetal death. A prediction algorithm can help identifying the highest risk group (Doppler deterioration and early presentation). Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort. This article is protected by copyright. All rights reserved.

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