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Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.
Prasad, Smriti; Khalil, Asma; Kirkham, Jamie J; Sharp, Andrew; Woolfall, Kerry; Mitchell, Tracy Karen; Yaghi, Odai; Ricketts, Tracey; Popa, Mariana; Alfirevic, Zarko; Anumba, Dilly; Ashcroft, Richard; Attilakos, George; Bailie, Carolyn; Baschat, Ahmet A; Cornforth, Christine; Costa, Fabricio Da Silva; Denbow, Mark; Deprest, Jan; Fenwick, Natasha; Haak, Monique C; Hardman, Louise; Harrold, Jane; Healey, Andy; Hecher, Kurt; Parasuraman, Rajeswari; Impey, Lawrence; Jackson, Richard; Johnstone, Edward; Leven, Shauna; Lewi, Liesbeth; Lopriore, Enrico; Oconnor, Isabella; Harding, Danielle; Marsden, Joel; Mendoza, Jessica; Mousa, Tommy; Nanda, Surabhi; Papageorghiou, Aris T; Pasupathy, Dharmintra; Sandall, Jane; Thangaratinam, Shakila; Thilaganathan, Baskaran; Turner, Mark; Vollmer, Brigitte; Watson, Michelle; Wilding, Karen; Yinon, Yoav.
Afiliación
  • Prasad S; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Khalil A; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Kirkham JJ; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
  • Sharp A; Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK.
  • Woolfall K; Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
  • Mitchell TK; Department of Women's and Children's Health, Faculty of Health & Life Sciences, Harris Wellbeing of Women Research Centre, University of Liverpool, Liverpool, UK.
  • Yaghi O; Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • Ricketts T; Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • Popa M; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Alfirevic Z; Department of Women's and Children's Health, Faculty of Health & Life Sciences, Harris Wellbeing of Women Research Centre, University of Liverpool, Liverpool, UK.
  • Anumba D; Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
  • Ashcroft R; Department of Women's and Children's Health, Faculty of Health & Life Sciences, Harris Wellbeing of Women Research Centre, University of Liverpool, Liverpool, UK.
  • Attilakos G; Academic Unit of Reproductive and Developmental Medicine, Department of Human Metabolism, University of Sheffield, Sheffield, UK.
  • Bailie C; City Law School, University of London, London, UK.
  • Baschat AA; Women's Health Division, University College London Hospitals NHS Foundation Trust, London, UK.
  • Cornforth C; Institute for Women's Health, University College London, London, UK.
  • Costa FDS; Fetal Medicine Unit, Royal Jubilee Maternity Hospital, Belfast, UK.
  • Denbow M; Department of Gynecology & Obstetrics, Johns Hopkins Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA.
  • Deprest J; Department of Women's and Children's Health, Faculty of Health & Life Sciences, Harris Wellbeing of Women Research Centre, University of Liverpool, Liverpool, UK.
  • Fenwick N; Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
  • Haak MC; Fetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
  • Hardman L; Fetal Medicine Unit, Department Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
  • Harrold J; Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.
  • Healey A; Twins Trust, Woking, UK.
  • Hecher K; Fetal Medicine Unit, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
  • Parasuraman R; Liverpool Women's NHS Foundation Trust, Liverpool, UK.
  • Impey L; Department of Women's and Children's Health, Faculty of Health & Life Sciences, Harris Wellbeing of Women Research Centre, University of Liverpool, Liverpool, UK.
  • Jackson R; King's Health Economics, Health Service and Population Research Department, King's College London, London, UK.
  • Johnstone E; Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Leven S; Wessex Fetal Maternal Medicine Unit, University Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, UK.
  • Lewi L; Department of Fetal Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Lopriore E; Department of Statistics, Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK.
  • Oconnor I; Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Medicine Biology and Health, University of Manchester, Manchester, UK.
  • Harding D; Twins Trust, Woking, UK.
  • Marsden J; Fetal Medicine Unit, Department Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
  • Mendoza J; Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium.
  • Mousa T; Department of Paediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
  • Nanda S; PPIE, FERN project, Harris Wellbeing of Women Research Centre, University of Liverpool, UK.
  • Papageorghiou AT; PPIE, FERN project, Harris Wellbeing of Women Research Centre, University of Liverpool, UK.
  • Pasupathy D; PPIE, FERN project, Harris Wellbeing of Women Research Centre, University of Liverpool, UK.
  • Sandall J; PPIE, FERN project, Harris Wellbeing of Women Research Centre, University of Liverpool, UK.
  • Thangaratinam S; Maternal and Fetal Medicine Unit, University of Leicester, Leicester, UK.
  • Thilaganathan B; Fetal Medicine Unit, Guy's and St Thomas's Hospital, Evelina London Children's Hospital, King's College London, London, UK.
  • Turner M; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Vollmer B; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
  • Watson M; Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  • Wilding K; Division of Women's Health, King's College London, Women's Health Academic Centre, King's Health Partners, London, UK.
  • Yinon Y; WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
BJOG ; 131(12): 1684-1693, 2024 Nov.
Article en En | MEDLINE | ID: mdl-38956742
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Gemelos Monocigóticos / Pautas de la Práctica en Medicina / Retardo del Crecimiento Fetal / Embarazo Gemelar Límite: Female / Humans / Pregnancy Idioma: En Revista: BJOG Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Gemelos Monocigóticos / Pautas de la Práctica en Medicina / Retardo del Crecimiento Fetal / Embarazo Gemelar Límite: Female / Humans / Pregnancy Idioma: En Revista: BJOG Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido