Perinatal outcomes of monochorionic multigestational pregnancies with different types of selective fetal growth restriction
Gladkova K.A., Frolova E.R., Sakalo V.A., Kostyukov K.V.
Background: Selective fetal growth restriction (sFGR) complicates 10–15% of pregnancies with monochorionic twins and is characterized by discordant fetal growth and a high level of perinatal and neonatal morbidity and mortality. sFGR is classified into three types according to the Doppler pattern of blood flow in the umbilical artery (UA) in growth-restricted twins. Each type is associated with a specific clinical course and perinatal and neonatal outcomes and differs in the degree of uneven placental separation and the functioning of placental-vascular anastomoses.
Objective: To assess the perinatal outcomes of expectant management of monochorionic diamniotic twin pregnancies complicated by sFGR according to the type of UA blood flow disorder in growth-restricted twins.
Materials and methods: A retrospective cohort study was conducted at V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia from January 2017 to January 2024. The course of pregnancy in 128 women with monochorionic diamniotic twin pregnancies complicated by sFGR was analyzed. Group 1 included patients with type I sFGR (n=72), group 2 included patients with type II sFGR (n=37), and group 3 included patients with type III sFGR (n=19).
Results: Perinatal parameters varied depending on the sFGR type. Antenatal fetal growth discordance was significantly different from the first trimester of pregnancy in types I and II sFGR, with the highest discordance observed in group 2. The age at delivery in sFGR type I was greater than that in types II and III (34.2, 31.4 and 31.6 weeks, respectively; p<0.001). Type II sFGR was characterized by the worst outcomes, including the highest discordance in neonatal body weight (42.9%, p<0.001) and the lowest length/height-for-age indicators of growth-restricted children– 988.5 g, 36 cm; body weight: p1/2<0.001, p2/3=0.0012, length: p1/2<0.001, p2/3=0.049). The proportion of children with growth restriction and severe and moderate birth asphyxia (Apgar score<5) was significantly higher in types II and III sFGR. In our study, the overall survival rate was 92.2% (20 children died, including 6 (2.34%) antenatally and 14 (5.5%) postnatally). Antenatal fetal death with growth restriction occurred in four cases (1.56%) with sFGR types I and II and co-twin death in one patient in group 2. Statistically significant adverse perinatal outcomes (χ2=19.713; p=0.003) were observed for sFGR type II.
Conclusion: The course of multigestational pregnancies complicated by type II sFGR is characterized by the most adverse perinatal outcomes. The classification of sFGR according to the type of UA blood flow disorder should form the basis for an individual management plan for pregnant women, with the level of observation corresponding to the degree of risk for perinatal loss.
Authors' contributions: Gladkova K.A. – conception and design of the study, review of the relevant literature, structuring and drafting of the manuscript; Kostyukov K.V. – material collection, data analysis, editing of the manuscript; Frolova E.R., Sakalo V.A. – data acquisition for analysis and statistical analysis, drafting of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Gladkova K.A., Frolova E.R., Sakalo V.A., Kostyukov K.V. Perinatal outcomes of
monochorionic multigestational pregnancies with different types of selective fetal growth restriction.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (1): 35-43 (in Russian)
https://dx.doi.org/10.18565/aig.2024.322
Keywords
monochorionic pregnancy
twins
selective fetal growth restriction syndrome
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Received 16.12.2024
Accepted 27.12.2024
About the Authors
Kristina A. Gladkova, PhD, Senior Researcher at the Fetal Medicine Unit, Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology,V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(916)321-10-07, k_gladkova@oparina4.ru,
https://orcid.org/0000-0001-8131-4682
Ekaterina R. Frolova, PhD student at the 1st Obstetric Department of Pregnancy Pathology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-07-88, e_frolova@oparina4.ru, https://orcid.org/0000-0003-2817-3504
Viktoriya A. Sakalo, PhD, Junior Researcher at the Department of Pregnancy Pathology, Institute of Obstetrics, obstetrician-gynecologist at the 1st Obstetric Department of Pregnancy Pathology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(929)588-72-08, v_sakalo@oparina4.ru, https://orcid.org/0000-0002-5870-4655
Kirill V. Kostyukov, Dr. Med. Sci, Head of the Department of the Ultrasound and Functional Diagnosis, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
117997, Russia, Moscow, Ac. Oparin str., 4, +7(495)438-25-29, k_kostyukov@oparina4.ru, https://orcid.org/0000-0003-3094-4013
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