Antenatal course of referred monochorionic diamniotic twins complicated by selective intrauterine growth restriction (SIUGR) type III

J Matern Fetal Neonatal Med. 2021 Dec;34(23):3867-3873. doi: 10.1080/14767058.2019.1701648. Epub 2019 Dec 16.


Objective: To describe the antenatal course of selective intrauterine growth restriction (SIUGR) type III patients.

Study design: Retrospective study of monochorionic diamniotic twins with SIUGR type III. Patients were divided into those who did and did not progress to SIUGR type II or twin-twin transfusion syndrome (TTTS) (Groups A and B, respectively). Patient characteristics and perinatal survival were compared by Group, and continuous data are reported as median (range).

Results: Forty-eight patients were studied; Group A [26 (54.2%)] and Group B [22 (45.8%)]. The difference in 30-day survivorship for the appropriate for gestational age twin (88.5 vs. 100%, p = .2394) and for the SIUGR twin (73.1 vs. 95.5%, p = .0551) was not statistically significant. However, dual survivorship was lower in Group A compared to Group B (69.2 vs. 95.4%, p = .0276).

Conclusions: Approximately half of the SIUGR type III patients had antenatal progression. Lack of antenatal progression was associated with 95% dual survivorship.

Rationale: The antenatal course of monochorionic diamniotic twins complicated by SIUGR type III is not well-understood and antenatal management remains a clinical dilemma. We provide pregnancy outcomes in a referred group of SIUGR type III patients, including the rate of progression to SIUGR type II and TTTS.

Keywords: End-diastolic flow; fetal growth discordance; laser surgery; preterm; twin–twin transfusion syndrome; umbilical artery Doppler.

MeSH terms

  • Female
  • Fetal Growth Retardation* / epidemiology
  • Fetofetal Transfusion*
  • Gestational Age
  • Humans
  • Pregnancy
  • Pregnancy, Twin
  • Retrospective Studies
  • Twins, Monozygotic