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Online ISSN
1305-3124

Established
1993

Editors-in-Chief
​Cihat Şen, ​Nicola Volpe

Editors
Daniel Rolnik, Mar Gil, Murat Yayla, Oluş Api

Statistics Editor
Resul Arısoy

Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas

Kaouther Dimassi, Meriem Ajroudi, Asma Hamdi, Dalenda Chelli, Amel Triki, Mohamed Faouzi Gara

Article info

Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas. Perinatal Journal 2014;22(3):SE4 DOI: 10.2399/prn.14.S001084

Author(s) Information

Kaouther Dimassi1,
Meriem Ajroudi1,
Asma Hamdi2,
Dalenda Chelli2,
Amel Triki1,
Mohamed Faouzi Gara1

  1. Department of Obstetrics and Gynecology, Mongi Slim Hospital- La Marsa TN
  2. Department A of Gynecology and Obstetrics, Tunisian Maternity and Neonatology Center, Rabta TN
Correspondence

Kaouther Dimassi, Department of Obstetrics and Gynecology, Mongi Slim Hospital- La Marsa TN,

Publication History
Conflicts of Interest

No conflicts declared.

Objective
Selective intrauterine growth restriction (sIUGR) in monochorionic (MC) twins is associated with a substantial increase in perinatal mortality and morbidity for both twins. Clinical evolution depends on the combination of the effects of placental insufficiency in the IUGR twin with inter-twin blood transfer through
placental anastomoses.
Cases 1
It is about a 30 years old women with a Spontaneous monochorionic twin pregnancy. A selective intrauterine growth restriction type 2 was diagnosed at 22 WA with a persistent absent diastolic flow in the umbilical Doppler of the twin with IUGR. The evolution was marked by the deterioration of the Doppler waveforms and the appearance of a reversed end-diastolic flow at 29 WA.
Then, because of the faltering growth and the appearance of the appearance of
A reverse atrial flow in the Ductus venosus, a cesarian section was performed at 32 WA. Birth weights were respectively 1200gr and 1800gr for the twin with IUGR and the larger twin. The latest died of a hyaline membrane disease after 5 days.
Case 2
It is about a Spontaneous monochorionic diamniotic twin pregnancy with a diagnosis of a type 2 sIUGR at 26 WA. Monitoring was regular and based on the study of fetal growth, and Doppler waveforms. The evolution was marked by a persistent absent diastolic flow in the umbilical Doppler of the twin with sIUGR and the conservation of growth in both twins. Delivery was scheduled at 34 WA. The birth weights were of 1300g and 1700g. At the age of 6 mouths, the pediatric exam did not revealed any brain injury for both twins.
Conclusion
SIUGR is a common condition associated with MC pregnancy. It is increasingly considered to be an important complication of MC twins, with potentially significant risks of intrauterine fetal demise or neurological adverse outcome for both twins. Introduction of skilled sonographic evaluation, a better understanding of different Doppler patterns and of the anatomy of MC placenta, together with the development of fetoscopic techniques have all contributed to a deeper scientific understanding of this condition.
Keywords

Intra uterine growth restriction,Monochorionic,Twins,Doppler waveforms

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File/Dsecription
Figure
Cordal insertion of twin with sIUGR
Figure 2
Persistent absent diastolic flow in twin with sIUGR