Is growth restriction in twin pregnancies a double challenge? – A narrative review
, , and | Jul 06, 2021
Article Category: Case study
Published Online: Jul 06, 2021
Page range: 24 - 30
DOI: https://doi.org/10.34763/jmotherandchild.20202404.d-20-00016
Keywords
© 2021 Dagmara Filipecka-Tyczka et al. published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Background
Foetal growth restriction (FGR) complicates about 25–47% of twin pregnancies. One or both foetuses can be restricted. Pregnancies with discordant growth of foetuses are associated with a sevenfold increased risk of neonatal morbidity.
Materials and methods
This is a narrative or traditional literature review. A literature search was performed to present a comprehensive, critical and objective analysis of the current knowledge on growth restriction in twin pregnancies.
Results
The definitions of FGR in twin pregnancies and selective FGR (sFGR) differ between international societies. In 2019, the Delphi procedure aimed to unify the definitions of sFGR in twin pregnancies. Several growth charts for twins have been published. However, most societies recommend singleton growth charts as better in detecting hypoxic complications of FGR in twin pregnancies. Discordant growth in twins results from placental insufficiency, congenital anomalies, chromosomal aberrations and TORCH infections.
Conclusions
Definitions and management of sFGR depend on chorionicity. The management aims to protect the properly growing foetus from ischemic complications or in utero death. In most cases, expectant management, strict surveillance and preterm labour are the methods of choice. Due to the co-existence of properly growing and small foetuses in one uterus, determining the appropriate time for delivery is challenging. In the case of preterm labour, even late preterm, antenatal corticosteroid therapy (ACT) in FGR twin pregnancies is beneficial because it decreases neonatal morbidity.