Possible molecular and biological mechanisms for the development of selective fetal growth restriction in monochorionic twin pregnancy

Neftereva A.A., Sakalo V.A., Gladkova K.A., Kоstyukov K.V., Khodzhaeva Z.S.

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia
Fetal growth restriction is a key problem of modern obstetrics, which is accompanied by high perinatal mortality and morbidity rates. Selective fetal growth restriction is a monochorionic twin pregnancy complication that occurs in 10–15% of cases and significantly increases the probability of antenatal death of one of the fetuses, as well as the development of severe neurological complications in the newborn. The perinatal risks are significantly higher in twin pregnancies than those in singlet pregnancies. The most problem pregnancy is that with monochorionic placentation, which accounts for up to 60% of all complications, while the risk of death of the other fetus and the development of neurological complications in the newborn is 3 times higher than that with a dichorionic twin pregnancy. The paper searches and analyzes the data available in the world literature on studies of the key determinants of the development of selective fetal growth restriction in monochorionic twin pregnancy. The current fundamental aspects of the pathogenesis of this process are analyzed in detail. The paper presents the possibilities of studying angiogenesis and vasculogenesis of the monochorial placenta and epigenetic factors as a predictor at the preclinical stage of selective fetal growth restriction.
Conclusion: Selective fetal growth restriction is a serious complication of monochorionic twin pregnancy, since it is associated not only with the antenatal death of a low-weight fetus, but also with a decrease in the quality of life up to childhood disability of the surviving twin. It is necessary to conduct further investigations to develop optimal management tactics for pregnant women, as well as to predict the fetuses’ condition after birth.


monochorionic twin pregnancy
selective fetal growth restriction
angiogenic factors
epigenetic factors


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Received 16.07.2021

Accepted 07.09.2021

About the Authors

Alina A. Neftereva, clinical resident, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Healthcare of Russian Federation, +7(915)605-94-90, nefterevaalina@mail.ru, 117997, Russia, Moscow, Ac. Oparina str., 4.
Victoria A. Sakalo, doctor of the 1st Obstetric Department of Pregnancy Pathology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation, +7(929)588-72-08, v_sakalo@oparina4.ru, 117997, Russia, Moscow, Ac. Oparina str., 4.
Kristina A. Gladkova, Ph.D, Senior Researcher of the Fetal Medicine Unit, Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation,
+7(916)321-10-07, k_gladkova@oparina4.ru, 117997, Russia, Moscow, Ac. Oparina str., 4.
Kirill V. Kostyukov, PhD, Senior Researcher of the Fetal Medicine Unit, Institute of Obstetrics, doctor of the Department of the Ultrasound and Functional Diagnosis, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation,
+7(926)214-97-84, kostyukov_k@yahoo.com, 117997, Russia, Moscow, Ac. Oparina str., 4.
Zulfiya S. Khodzhaeva, Dr. Med. Sci., Professor, Deputy director of Obstetrics Institute, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation, +7(916)407-75-67, zkhodjaeva@mail.ru, 117997, Russia, Moscow, Ac. Oparina str., 4.

Authors’ contributions: Neftereva A.A., Khodzhaeva Z.S. – choosing a research topic; Neftereva A.A., Sakalo V.A., Gladkova K.A., Kоstyukov K.V. – searching for literature data; Neftereva A.A., Sakalo V.A. – writing the manuscript
in the article; Khodzhaeva Z.S., Gladkova K.A. – writing and editing the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation was conducted within the framework of State Assignment No. 21-A21,
State Registration No. 121040600434-3.
For citation: Neftereva A.A., Sakalo V.A., Gladkova K.A., Kоstyukov K.V., Khodzhaeva Z.S. Possible molecular and biological mechanisms for the development
of selective fetal growth restriction in monochorionic twin pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 10: 5-12 (in Russian)

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