Survival Outcomes by Fetal Weight Discordance after Laser Surgery for Twin-Twin Transfusion Syndrome Complicated by Donor Fetal Growth Restriction

2020 ◽  
pp. 1-10
Author(s):  
Lauryn C. Gabby ◽  
Andrew H. Chon ◽  
Lisa M. Korst ◽  
Arlyn Llanes ◽  
David A. Miller ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Laser Surgery ◽  
Growth Restriction ◽  
Fetal Weight ◽  
Survival Outcomes

DIAGNOSIS AND MANAGEMENT OF SELECTIVE FETAL GROWTH RESTRICTION IN MONOCHORIONIC TWINS

2009 ◽  
Vol 20 (4) ◽  
pp. 269-281 ◽  
Author(s):  
EDUARD GRATACÓS ◽  
ELISENDA EIXARCH ◽  
FATIMA CRISPI
Keyword(s):  
Fetal Growth ◽  
Common Sense ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Fetal Weight ◽  
Abdominal Circumference ◽  
Monochorionic Twins ◽  
Normal Ranges ◽  
Estimated Fetal Weight ◽  
Simple Definition

Selective fetal growth restriction (sFGR) has been reported to occur in about 10–15% of monochorionic (MC) twins. The diagnosis of sFGR has been based on variable criteria including estimated fetal weight (EFW), abdominal circumference and/or the degree of fetal weight discordance. Recent studies tend to use a simple definition which includes the presence of an EFW less than the 10th percentile in the smaller twin. Some would argue that the intertwin fetal weight discordance should be included in the definition. Indeed this factor plays a major role in the complications presented by these cases. While the majority of cases with one fetus below the 10th percentile usually will also present with a large intertwin EFW discordance, the contrary is not always true. Thus, it is possible to find MC twins with remarkable intertwin EFW discordance but the EFW of both fetuses are still within normal ranges. Although it appears to be common sense that a large intertwin discrepancy might represent a higher risk for some of the complications described later in this review, there is no consistent evidence to support this notion. Therefore, due to its simplicity, a definition based on an EFW below 10th percentile in one twin is probably the most useful for clinical and research purposes.

scholarly journals Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome

2019 ◽  
Vol 8 (7) ◽  
pp. 969 ◽  
Author(s):  
Groene ◽  
Tollenaar ◽  
van Klink ◽  
Haak ◽  
Klumper ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Laser Surgery ◽  
Growth Restriction ◽  
Separate Analysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Short And Long Term ◽  
Perinatal Survival

As twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are both prevalent complications of monochorionic (MC) twin pregnancies, its coexistence is not uncommon. The aim of this study is to evaluate the short and long-term outcome in TTTS with and without sFGR prior to fetoscopic laser coagulation. All TTTS cases treated with laser surgery at our center between 2001–2019 were retrospectively reviewed for the presence of sFGR, defined as an estimated fetal weight (EFW) <10th centile. We compared two groups: TTTS-only and TTTS + sFGR. Primary outcomes were perinatal survival and long-term severe neurodevelopmental impairment (NDI). Of the 527 pregnancies eligible for analysis, 40.8% (n = 215) were categorized as TTTS-only and 59.2% (n = 312) as TTTS + sFGR. Quintero stage at presentation was higher in the TTTS + sFGR group compared to the TTTS-only group (57% compared to 44% stage III). Separate analysis of donors showed significantly lower perinatal survival for donors in the TTTS + sFGR group (72% (224/311) compared to 81% (173/215), p = 0.027). Severe NDI at follow-up in long-term survivors in the TTTS-only and TTTS + sFGR group was present in 7% (13/198) and 9% (27/299), respectively (p = 0.385). Both sFGR (OR 1.5;95% CI 1.1–2.0, p = 0.013) and lower gestational age at laser (OR 1.1;95% CI 1.0–1.1, p = 0.001) were independently associated with decreased perinatal survival. Thus, sFGR prior to laser surgery is associated with a more severe initial presentation and decreased donor perinatal survival. The long-term outcome was not affected.

scholarly journals Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction

2015 ◽  
Vol 38 (2) ◽  
pp. 86-93 ◽  
Author(s):  
Gergana Peeva ◽  
Sarah Bower ◽  
Laszlo Orosz ◽  
Petya Chaveeva ◽  
Ranjit Akolekar ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Laser Surgery ◽  
Cervical Length ◽  
Growth Restriction ◽  
Ductus Venosus ◽  
Laser Coagulation ◽  
Multivariable Logistic Regression Analysis ◽  
Type Ii ◽  
Discharge From Hospital

Objective: To determine predictors of survival in monochorionic diamniotic twins with selective fetal growth restriction type II (sFGR-II), with or without twin-to-twin transfusion syndrome (TTTS), treated by endoscopic placental laser coagulation. Methods: Laser surgery was performed at 20 (15-27) weeks' gestation in 405 cases of sFGR-II with and 142 without coexisting TTTS. Multivariable logistic regression analysis was performed to determine significant predictors of survival to discharge from hospital. Results: There was survival of the small twin in 216 (39.5%) and of the large twin in 379 (69.3%) cases. Significant predictors of survival of both the small and larger twin were ductus venosus Doppler findings in the small twin, gestational age at laser and cervical length, but not the presence of TTTS or Doppler findings in the large twin. Conclusions: In sFGR-II, survival after laser surgery is primarily dependent on the condition of the small twin.

scholarly journals Sildenafil Citrate Increases Fetal Weight in a Mouse Model of Fetal Growth Restriction with a Normal Vascular Phenotype

PLoS ONE ◽  
2013 ◽  
Vol 8 (10) ◽  
pp. e77748 ◽  
Author(s):  
Mark Robert Dilworth ◽  
Irene Andersson ◽  
Lewis James Renshall ◽  
Elizabeth Cowley ◽  
Philip Baker ◽  
...  
Keyword(s):  
Mouse Model ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Fetal Weight ◽  
Sildenafil Citrate ◽  
Vascular Phenotype

scholarly journals Absence of TRPC1 Ca2+-permeable Channel Causes Placental and Fetal Growth Restriction in Mice

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 732-732
Author(s):  
Kate Claycombe-Larson ◽  
Amy Bundy ◽  
James Roemmich ◽  
Brij Singh
Keyword(s):  
Growth Factor ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth And Development ◽  
Branching Morphogenesis ◽  
Growth Restriction ◽  
Fetal Weight ◽  
High Fat ◽  
Vegf Mrna ◽  
Placental Dysfunction

Abstract Objectives Placental tissue intracellular calcium (Ca2+) regulates placental development and growth (e.g., blastocyst development through branching morphogenesis). Maternal high-fat (HF) diet results in placental lipid accumulation, increase in inflammation, reduction in nutrient transport expression and intra uterine growth restriction (IUGR). Currently, whether maternal HF diet affects placental and fetal growth and development differentially under reduction in Ca2 + influx is not known. Thus, we hypothesized that maternal HF diet feeding decreases placental growth and development resulting in IUGR. We further hypothesized that reduction of Ca2 + influx in placenta worsens the maternal HF-induced placental dysfunction. Methods Two-month old female B6129SF2/J wild type (WT) and transient receptor potential canonical 1 (TRPC1) protein deficient (KO) mice were fed normal fat (NF, 16% fat) and high fat (HF, 45%) diets for 12 weeks. Fetuses and placentae were examined at mid- (D12) and late- (D19) gestation. Results Placental length, width, and weight as well as fetal weight were decreased in the TRPC1KO mice at D12 and D19 compared to that of WT mice. Expression of placental growth factor (PLGF) mRNA was decreased at D12 in TRPC1 KO mice while vascular endothelial growth factor (VEGF) mRNA levels were increased at D19 compared to WT mice. Conclusions These findings suggest that genotypic differences rather than maternal HF diet alter placental size and weight as well as fetal weight. Decreased in PLGF mRNA may be responsible for the placental and fetal growth restriction while increase in VEGF mRNA indicates compensatory adaptation to decreased PLGF-associated placental and fetal growth restriction. Future studies are needed to determine the signaling mechanism underlying Ca2 + influx reduction- induced placental dysfunction and IUGR. Funding Sources USDA Agricultural Research Service Project #3062–51,000-054–00D.

Sign in / Sign up

Export Citation Format

Share Document