Classification and Management of Selective Fetal Growth Restriction (sFGR) in Monochorionic Twin Pregnancies
Classification of sFGR Types
- Selective fetal growth restriction (sFGR) in monochorionic twin pregnancies is classified into three distinct types based on umbilical artery Doppler findings in the growth-restricted twin, each with different prognosis and management implications, according to the American College of Radiology 1
- Type I sFGR is characterized by constant end-diastolic flow (EDF) in the umbilical artery of the growth-restricted twin, as defined by the American College of Radiology 1
- Type II sFGR is characterized by constant absent or reversed end-diastolic flow in the umbilical artery of the growth-restricted twin and is associated with poorest outcomes and highest risk of intrauterine fetal demise, as reported by the American College of Radiology 1
- Type III sFGR is characterized by intermittent absent or reversed end-diastolic flow in the umbilical artery of the growth-restricted twin, according to the American College of Radiology 1
Diagnostic Criteria for sFGR
- Estimated fetal weight (EFW) discordance ≥ 25% is a contributory parameter for diagnosing sFGR in monochorionic twins, as stated by the American College of Radiology 2
Management Approach
- Management of sFGR requires close monitoring with weekly assessment of fetal well-being, including Doppler of the umbilical artery and middle cerebral artery, as recommended by the American College of Radiology 3, 4
- Biweekly fetal biometry evaluations are necessary for monitoring sFGR, according to the American College of Radiology 3, 4
- Consideration of delivery timing based on sFGR type and severity is crucial, as suggested by the American Journal of Obstetrics and Gynecology 5
- Consultation with specialized fetal care centers is recommended for advanced cases of sFGR, according to the American Journal of Obstetrics and Gynecology 6