Prasad, Smriti, Khalil, Asma, Kirkham, Jamie J, Sharp, Andrew 
ORCID: 0000-0003-3396-7464, Woolfall, Kerry, Mitchell, Tracy Karen, Yaghi, Odai, Ricketts, Tracey, Popa, Mariana, Alfirevic, Zarko et al (show 39 more authors)
(2024)
Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.
BJOG : an international journal of obstetrics and gynaecology.
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Abstract
<h4>Objective</h4>To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.<h4>Design</h4>Cross-sectional survey.<h4>Setting</h4>International.<h4>Population</h4>Clinicians involved in the management of MCDA twin pregnancies with sFGR.<h4>Methods</h4>A structured, self-administered survey.<h4>Main outcome measures</h4>Clinical practices and attitudes to diagnostic criteria and management strategies.<h4>Results</h4>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) and 57.1% (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 I sFGR, 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 III sFGR 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.<h4>Conclusions</h4>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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FERN Study Team |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 03 Jul 2024 13:11 |
| Last Modified: | 05 Jul 2024 00:51 |
| DOI: | 10.1111/1471-0528.17891 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3182620 |
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