TY - JOUR
T1 - Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies
T2 - A cross-sectional international survey
AU - FERN Study Team
AU - Prasad, Smriti
AU - Khalil, Asma
AU - Kirkham, Jamie J.
AU - Sharp, Andrew
AU - Woolfall, Kerry
AU - Mitchell, Tracy Karen
AU - Yaghi, Odai
AU - Ricketts, Tracey
AU - Popa, Mariana
AU - Alfirevic, Zarko
AU - Anumba, Dilly
AU - Ashcroft, Richard
AU - Attilakos, George
AU - Bailie, Carolyn
AU - Baschat, Ahmet A.
AU - Cornforth, Christine
AU - Costa, Fabricio Da Silva
AU - Denbow, Mark
AU - Deprest, Jan
AU - Fenwick, Natasha
AU - Haak, Monique C.
AU - Hardman, Louise
AU - Harrold, Jane
AU - Healey, Andy
AU - Hecher, Kurt
AU - Parasuraman, Rajeswari
AU - Impey, Lawrence
AU - Jackson, Richard
AU - Johnstone, Edward
AU - Leven, Shauna
AU - Lewi, Liesbeth
AU - Lopriore, Enrico
AU - Oconnor, Isabella
AU - Harding, Danielle
AU - Marsden, Joel
AU - Mendoza, Jessica
AU - Mousa, Tommy
AU - Nanda, Surabhi
AU - Papageorghiou, Aris T.
AU - Pasupathy, Dharmintra
AU - Sandall, Jane
AU - Thangaratinam, Shakila
AU - Thilaganathan, Baskaran
AU - Turner, Mark
AU - Vollmer, Brigitte
AU - Watson, Michelle
AU - Wilding, Karen
AU - Yinon, Yoav
N1 - Publisher Copyright:
© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
KW - clinical trial
KW - cord occlusion
KW - definition
KW - diagnosis
KW - fetal growth restriction
KW - feticide
KW - fetoscopic laser surgery
KW - intervention
KW - intrauterine demise
KW - morbidity
KW - mortality
KW - multiple
KW - neonatal
KW - pregnancy
KW - prognosis
KW - small for gestational age
KW - stillbirth
KW - surgery
KW - survey
UR - http://www.scopus.com/inward/record.url?scp=85197904298&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.17891
DO - 10.1111/1471-0528.17891
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C2 - 38956742
AN - SCOPUS:85197904298
SN - 1470-0328
VL - 131
SP - 1684
EP - 1693
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 12
ER -