Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey

Smriti  Prasad; Asma  Khalil; Jamie Kirkham; Andrew  Sharp; Kerry  Woolfall; Tracy Karen  Mitchell; Odai  Yaghi; Tracey  Ricketts; Mariana  Popa; Zarko  Alfirevic; Dilly  Anumba; Richard  Ashcroft; George  Attilakos; Carolyn Bailie; Ahmet A.  Baschat; Christine  Cornforth; Fabricio  Da Silva Costa; Mark  Denbow; Jan  Deprest; Natasha  Fenwick; Monique C.  Haak; Louise  Hardman; Jane  Harrold; Andy  Healey; Kurt  Hecher; Rajeswari  Parasuraman; Lawrence  Impey; Richard  Jackson; Edward  Johnstone; Shauna  Leven; Liesbeth  Lewi; Enrico  Lopriore; Isabella  Oconnor; Danielle  Harding; Joel Marsden; Jessica  Mendoza; Tommy  Mousa; Surabhi  Nanda; Aris T.  Papageorghiou; Dharmintra  Pasupathy; Jane  Sandall; Shakila  Thangaratinam; Baskaran  Thilaganathan; Mark  Turner; Brigitte  Vollmer; Michelle  Watson; Karen  Wilding; Yoav  Yinon

doi:10.1111/1471-0528.17891

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey

Smriti Prasad, Asma Khalil, Jamie Kirkham, Andrew Sharp, Kerry Woolfall, Tracy Karen Mitchell, Odai Yaghi, Tracey Ricketts, Mariana Popa, Zarko Alfirevic, Dilly Anumba, Richard Ashcroft, George Attilakos, Carolyn Bailie, Ahmet A. Baschat, Christine Cornforth, Fabricio Da Silva Costa, Mark Denbow, Jan Deprest, Natasha FenwickMonique C. Haak, Louise Hardman, Jane Harrold, Andy Healey, Kurt Hecher, Rajeswari Parasuraman, Lawrence Impey, Richard Jackson, Edward Johnstone, Shauna Leven, Liesbeth Lewi, Enrico Lopriore, Isabella Oconnor, Danielle Harding, Joel Marsden, Jessica Mendoza, Tommy Mousa, Surabhi Nanda, Aris T. Papageorghiou, Dharmintra Pasupathy, Jane Sandall, Shakila Thangaratinam, Baskaran Thilaganathan, Mark Turner, Brigitte Vollmer, Michelle Watson, Karen Wilding, Yoav Yinon

Division of Population Health, Health Services Research & Primary Care (L5)

Research output: Contribution to journal › Article › peer-review

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Abstract

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) and57.1% (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 IsFGR, 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 IIIsFGR 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.

Original language	English
Pages (from-to)	1684-1693
Number of pages	10
Journal	BJOG
Volume	131
Issue number	12
Early online date	2 Jul 2024
DOIs	https://doi.org/10.1111/1471-0528.17891
Publication status	Published - 1 Nov 2024

Keywords

clinical trial
cord occlusion
definition
diagnosis
etal growth restriction,
feticide
fetoscopic laser surgery
survey
intervention
intrauterine demise
morbidity
mortality
neonatal
pregnancy
small for gestational age

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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BJOG - 2024 - Prasad - Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies AFinal published version, 466 KBLicence: CC BY

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Prasad, S., Khalil, A., Kirkham, J., Sharp, A., Woolfall, K., Mitchell, T. K., Yaghi, O., Ricketts, T., Popa, M., Alfirevic, Z., Anumba, D., Ashcroft, R., Attilakos, G., Bailie, C., Baschat, A. A., Cornforth, C., Da Silva Costa, F., Denbow, M., Deprest, J., ... Yinon, Y. (2024). Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey. BJOG, 131(12), 1684-1693. https://doi.org/10.1111/1471-0528.17891

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title = "Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey",

abstract = "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) and57.1% (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 IsFGR, 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 IIIsFGR 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.",

keywords = "clinical trial, cord occlusion, definition, diagnosis, etal growth restriction,, feticide, fetoscopic laser surgery, survey, intervention, intrauterine demise, morbidity, mortality, neonatal, pregnancy, small for gestational age",

author = "Smriti Prasad and Asma Khalil and Jamie Kirkham and Andrew Sharp and Kerry Woolfall and Mitchell, {Tracy Karen} and Odai Yaghi and Tracey Ricketts and Mariana Popa and Zarko Alfirevic and Dilly Anumba and Richard Ashcroft and George Attilakos and Carolyn Bailie and Baschat, {Ahmet A.} and Christine Cornforth and {Da Silva Costa}, Fabricio and Mark Denbow and Jan Deprest and Natasha Fenwick and Haak, {Monique C.} and Louise Hardman and Jane Harrold and Andy Healey and Kurt Hecher and Rajeswari Parasuraman and Lawrence Impey and Richard Jackson and Edward Johnstone and Shauna Leven and Liesbeth Lewi and Enrico Lopriore and Isabella Oconnor and Danielle Harding and Joel Marsden and Jessica Mendoza and Tommy Mousa and Surabhi Nanda and Papageorghiou, {Aris T.} and Dharmintra Pasupathy and Jane Sandall and Shakila Thangaratinam and Baskaran Thilaganathan and Mark Turner and Brigitte Vollmer and Michelle Watson and Karen Wilding and Yoav Yinon",

year = "2024",

month = nov,

day = "1",

doi = "10.1111/1471-0528.17891",

language = "English",

volume = "131",

pages = "1684--1693",

journal = "BJOG",

issn = "1470-0328",

publisher = "John Wiley & Sons Ltd",

number = "12",

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Prasad, S, Khalil, A, Kirkham, J, Sharp, A, Woolfall, K, Mitchell, TK, Yaghi, O, Ricketts, T, Popa, M, Alfirevic, Z, Anumba, D, Ashcroft, R, Attilakos, G, Bailie, C, Baschat, AA, Cornforth, C, Da Silva Costa, F, Denbow, M, Deprest, J, Fenwick, N, Haak, MC, Hardman, L, Harrold, J, Healey, A, Hecher, K, Parasuraman, R, Impey, L, Jackson, R, Johnstone, E, Leven, S, Lewi, L, Lopriore, E, Oconnor, I, Harding, D, Marsden, J, Mendoza, J, Mousa, T, Nanda, S, Papageorghiou, AT, Pasupathy, D, Sandall, J, Thangaratinam, S, Thilaganathan, B, Turner, M, Vollmer, B, Watson, M, Wilding, K & Yinon, Y 2024, 'Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey', BJOG, vol. 131, no. 12, pp. 1684-1693. https://doi.org/10.1111/1471-0528.17891

TY - JOUR

T1 - Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey

AU - Prasad, Smriti

AU - Khalil, Asma

AU - Kirkham, Jamie

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 - Da Silva Costa, Fabricio

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

PY - 2024/11/1

Y1 - 2024/11/1

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) and57.1% (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 IsFGR, 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 IIIsFGR 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) and57.1% (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 IsFGR, 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 IIIsFGR 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 - etal growth restriction,

KW - feticide

KW - fetoscopic laser surgery

KW - survey

KW - intervention

KW - intrauterine demise

KW - morbidity

KW - mortality

KW - neonatal

KW - pregnancy

KW - small for gestational age

UR - http://www.scopus.com/inward/record.url?scp=85197904298&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.17891

DO - 10.1111/1471-0528.17891

M3 - Article

SN - 1470-0328

VL - 131

SP - 1684

EP - 1693

JO - BJOG

JF - BJOG

IS - 12

ER -

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey

Abstract

Keywords

UN SDGs

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