Expectant management in type II selective intrauterine growth restriction and abnormal cord insertion in monochorionic twins
To assess perinatal outcome in type II monochorionic (MC) diamniotic twin pregnancies (DA) affected by selective intrauterine growth restriction (sIUGR) and abnormal cord insertion managed expectantly. A prospective longitudinal study from June 2008 and July 2011 on 24 MCDA sIUGR twins. sIUGR was de...
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| Veröffentlicht in: | Journal of perinatal medicine 2013-05, Vol.41 (3), p.309-316 |
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| creator | Visentin, Silvia Macchi, Veronica Grumolato, Francesca Porzionato, Andrea De Caro, Raffaele Cosmi, Erich |
| description | To assess perinatal outcome in type II monochorionic (MC) diamniotic twin pregnancies (DA) affected by selective intrauterine growth restriction (sIUGR) and abnormal cord insertion managed expectantly.
A prospective longitudinal study from June 2008 and July 2011 on 24 MCDA sIUGR twins. sIUGR was defined as estimated fetal weight below the 10th percentile in one twin and was classified into three groups based on umbilical artery (UA) Doppler diastolic flow (I: presence; II: constantly absent/reverse (AEDF/ARED); III: intermittently absent or reverse). Marginal cord insertion was defined as insertion within 2 cm of the placental disc edge, and velamentous insertion as a cord insertion into the fetal membranes. Expectant management was chosen in these twins, and absent or reverse A wave in the ductus venosus (DV) was a criterion for delivery. Neonatal outcome was available for all twins delivered. Pathological examination and vascular cast of placentas were performed in all cases.
Fourteen twin pregnancies were type II sIUGR, and ten presented an abnormal umbilical cord insertion. Median gestational age (GA) at diagnosis of sIUGR was 18 weeks' gestation (range 16-20 weeks), and all sIUGR co-twins showed AEDF of UA at a median gestational age of 20 weeks (range 18-22 weeks). Median gestational age at delivery was 30 weeks (range 28-34 weeks) with a median birth weight of 1285 g (range 307-1725 g). pH at birth and base excess (BE) were normal in all IUGR co-twin (pH>7.10, median BE 5.5); Apgar score at 5 min was >7. Perinatal outcome was favorable in all cases. Placental pathological examination confirmed the marginal insertion of the umbilical cord and the absence of anastomosis between the two portions of umbilical insertion.
This study highlights that expectant management for sIUGR type II twins with or without an abnormal cord insertion should be a valid option to time delivery for these fetuses as shown by the favorable neonatal outcome. |
| doi_str_mv | 10.1515/jpm-2012-0133 |
| format | Article |
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A prospective longitudinal study from June 2008 and July 2011 on 24 MCDA sIUGR twins. sIUGR was defined as estimated fetal weight below the 10th percentile in one twin and was classified into three groups based on umbilical artery (UA) Doppler diastolic flow (I: presence; II: constantly absent/reverse (AEDF/ARED); III: intermittently absent or reverse). Marginal cord insertion was defined as insertion within 2 cm of the placental disc edge, and velamentous insertion as a cord insertion into the fetal membranes. Expectant management was chosen in these twins, and absent or reverse A wave in the ductus venosus (DV) was a criterion for delivery. Neonatal outcome was available for all twins delivered. Pathological examination and vascular cast of placentas were performed in all cases.
Fourteen twin pregnancies were type II sIUGR, and ten presented an abnormal umbilical cord insertion. Median gestational age (GA) at diagnosis of sIUGR was 18 weeks' gestation (range 16-20 weeks), and all sIUGR co-twins showed AEDF of UA at a median gestational age of 20 weeks (range 18-22 weeks). Median gestational age at delivery was 30 weeks (range 28-34 weeks) with a median birth weight of 1285 g (range 307-1725 g). pH at birth and base excess (BE) were normal in all IUGR co-twin (pH>7.10, median BE 5.5); Apgar score at 5 min was >7. Perinatal outcome was favorable in all cases. Placental pathological examination confirmed the marginal insertion of the umbilical cord and the absence of anastomosis between the two portions of umbilical insertion.
This study highlights that expectant management for sIUGR type II twins with or without an abnormal cord insertion should be a valid option to time delivery for these fetuses as shown by the favorable neonatal outcome.</description><identifier>EISSN: 1619-3997</identifier><identifier>DOI: 10.1515/jpm-2012-0133</identifier><identifier>PMID: 23241577</identifier><language>eng</language><publisher>Germany</publisher><subject>Adult ; Chorion - abnormalities ; Chorion - blood supply ; Diseases in Twins - classification ; Diseases in Twins - pathology ; Diseases in Twins - therapy ; Female ; Fetal Growth Retardation - classification ; Fetal Growth Retardation - pathology ; Fetal Growth Retardation - therapy ; Humans ; Infant, Newborn ; Longitudinal Studies ; Pregnancy ; Pregnancy Outcome ; Prognosis ; Prospective Studies ; Twins, Monozygotic ; Ultrasonography, Prenatal ; Umbilical Arteries - diagnostic imaging ; Umbilical Cord - abnormalities ; Umbilical Cord - diagnostic imaging</subject><ispartof>Journal of perinatal medicine, 2013-05, Vol.41 (3), p.309-316</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23241577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Visentin, Silvia</creatorcontrib><creatorcontrib>Macchi, Veronica</creatorcontrib><creatorcontrib>Grumolato, Francesca</creatorcontrib><creatorcontrib>Porzionato, Andrea</creatorcontrib><creatorcontrib>De Caro, Raffaele</creatorcontrib><creatorcontrib>Cosmi, Erich</creatorcontrib><title>Expectant management in type II selective intrauterine growth restriction and abnormal cord insertion in monochorionic twins</title><title>Journal of perinatal medicine</title><addtitle>J Perinat Med</addtitle><description>To assess perinatal outcome in type II monochorionic (MC) diamniotic twin pregnancies (DA) affected by selective intrauterine growth restriction (sIUGR) and abnormal cord insertion managed expectantly.
A prospective longitudinal study from June 2008 and July 2011 on 24 MCDA sIUGR twins. sIUGR was defined as estimated fetal weight below the 10th percentile in one twin and was classified into three groups based on umbilical artery (UA) Doppler diastolic flow (I: presence; II: constantly absent/reverse (AEDF/ARED); III: intermittently absent or reverse). Marginal cord insertion was defined as insertion within 2 cm of the placental disc edge, and velamentous insertion as a cord insertion into the fetal membranes. Expectant management was chosen in these twins, and absent or reverse A wave in the ductus venosus (DV) was a criterion for delivery. Neonatal outcome was available for all twins delivered. Pathological examination and vascular cast of placentas were performed in all cases.
Fourteen twin pregnancies were type II sIUGR, and ten presented an abnormal umbilical cord insertion. Median gestational age (GA) at diagnosis of sIUGR was 18 weeks' gestation (range 16-20 weeks), and all sIUGR co-twins showed AEDF of UA at a median gestational age of 20 weeks (range 18-22 weeks). Median gestational age at delivery was 30 weeks (range 28-34 weeks) with a median birth weight of 1285 g (range 307-1725 g). pH at birth and base excess (BE) were normal in all IUGR co-twin (pH>7.10, median BE 5.5); Apgar score at 5 min was >7. Perinatal outcome was favorable in all cases. Placental pathological examination confirmed the marginal insertion of the umbilical cord and the absence of anastomosis between the two portions of umbilical insertion.
This study highlights that expectant management for sIUGR type II twins with or without an abnormal cord insertion should be a valid option to time delivery for these fetuses as shown by the favorable neonatal outcome.</description><subject>Adult</subject><subject>Chorion - abnormalities</subject><subject>Chorion - blood supply</subject><subject>Diseases in Twins - classification</subject><subject>Diseases in Twins - pathology</subject><subject>Diseases in Twins - therapy</subject><subject>Female</subject><subject>Fetal Growth Retardation - classification</subject><subject>Fetal Growth Retardation - pathology</subject><subject>Fetal Growth Retardation - therapy</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Longitudinal Studies</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Twins, Monozygotic</subject><subject>Ultrasonography, Prenatal</subject><subject>Umbilical Arteries - diagnostic imaging</subject><subject>Umbilical Cord - abnormalities</subject><subject>Umbilical Cord - diagnostic imaging</subject><issn>1619-3997</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kD1PwzAQhi0kREthZEUeWQK-OI6TEVUFKlVi6R45zrVNFdvBdimV-PFYUKb7eN57dXeE3AF7BAHiaT-aLGeQZww4vyBTKKHOeF3LCbkOYc8YCCHyKzLJeV6AkHJKvhdfI-qobKRGWbVFgyntLY2nEelySQMOifefmJrRq0NE31ukW--OcUc9huj7xJ2lynZUtdZ5owaqne_SRED_y5KhcdbpnfOp7DWNxwRvyOVGDQFvz3FG1i-L9fwtW72_LufPq2wUpcyKsu3qEopNpZiAWhetaDm0hagZq2omeVWxVgPjCnm34aKsMJ2pJesU5BVKPiMPf7ajdx-HtHFj-qBxGJRFdwgN8EIWpRAlJOn9WXpoDXbN6Huj_Kn5fxj_Ab6qbRg</recordid><startdate>201305</startdate><enddate>201305</enddate><creator>Visentin, Silvia</creator><creator>Macchi, Veronica</creator><creator>Grumolato, Francesca</creator><creator>Porzionato, Andrea</creator><creator>De Caro, Raffaele</creator><creator>Cosmi, Erich</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201305</creationdate><title>Expectant management in type II selective intrauterine growth restriction and abnormal cord insertion in monochorionic twins</title><author>Visentin, Silvia ; Macchi, Veronica ; Grumolato, Francesca ; Porzionato, Andrea ; De Caro, Raffaele ; Cosmi, Erich</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p567-46bd9614f8a0519c4b5b31b4590089073880bc103ae3df3568e555c70da128e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Chorion - abnormalities</topic><topic>Chorion - blood supply</topic><topic>Diseases in Twins - classification</topic><topic>Diseases in Twins - pathology</topic><topic>Diseases in Twins - therapy</topic><topic>Female</topic><topic>Fetal Growth Retardation - classification</topic><topic>Fetal Growth Retardation - pathology</topic><topic>Fetal Growth Retardation - therapy</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Longitudinal Studies</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Twins, Monozygotic</topic><topic>Ultrasonography, Prenatal</topic><topic>Umbilical Arteries - diagnostic imaging</topic><topic>Umbilical Cord - abnormalities</topic><topic>Umbilical Cord - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Visentin, Silvia</creatorcontrib><creatorcontrib>Macchi, Veronica</creatorcontrib><creatorcontrib>Grumolato, Francesca</creatorcontrib><creatorcontrib>Porzionato, Andrea</creatorcontrib><creatorcontrib>De Caro, Raffaele</creatorcontrib><creatorcontrib>Cosmi, Erich</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of perinatal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Visentin, Silvia</au><au>Macchi, Veronica</au><au>Grumolato, Francesca</au><au>Porzionato, Andrea</au><au>De Caro, Raffaele</au><au>Cosmi, Erich</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Expectant management in type II selective intrauterine growth restriction and abnormal cord insertion in monochorionic twins</atitle><jtitle>Journal of perinatal medicine</jtitle><addtitle>J Perinat Med</addtitle><date>2013-05</date><risdate>2013</risdate><volume>41</volume><issue>3</issue><spage>309</spage><epage>316</epage><pages>309-316</pages><eissn>1619-3997</eissn><abstract>To assess perinatal outcome in type II monochorionic (MC) diamniotic twin pregnancies (DA) affected by selective intrauterine growth restriction (sIUGR) and abnormal cord insertion managed expectantly.
A prospective longitudinal study from June 2008 and July 2011 on 24 MCDA sIUGR twins. sIUGR was defined as estimated fetal weight below the 10th percentile in one twin and was classified into three groups based on umbilical artery (UA) Doppler diastolic flow (I: presence; II: constantly absent/reverse (AEDF/ARED); III: intermittently absent or reverse). Marginal cord insertion was defined as insertion within 2 cm of the placental disc edge, and velamentous insertion as a cord insertion into the fetal membranes. Expectant management was chosen in these twins, and absent or reverse A wave in the ductus venosus (DV) was a criterion for delivery. Neonatal outcome was available for all twins delivered. Pathological examination and vascular cast of placentas were performed in all cases.
Fourteen twin pregnancies were type II sIUGR, and ten presented an abnormal umbilical cord insertion. Median gestational age (GA) at diagnosis of sIUGR was 18 weeks' gestation (range 16-20 weeks), and all sIUGR co-twins showed AEDF of UA at a median gestational age of 20 weeks (range 18-22 weeks). Median gestational age at delivery was 30 weeks (range 28-34 weeks) with a median birth weight of 1285 g (range 307-1725 g). pH at birth and base excess (BE) were normal in all IUGR co-twin (pH>7.10, median BE 5.5); Apgar score at 5 min was >7. Perinatal outcome was favorable in all cases. Placental pathological examination confirmed the marginal insertion of the umbilical cord and the absence of anastomosis between the two portions of umbilical insertion.
This study highlights that expectant management for sIUGR type II twins with or without an abnormal cord insertion should be a valid option to time delivery for these fetuses as shown by the favorable neonatal outcome.</abstract><cop>Germany</cop><pmid>23241577</pmid><doi>10.1515/jpm-2012-0133</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; De Gruyter journals |
| subjects | Adult Chorion - abnormalities Chorion - blood supply Diseases in Twins - classification Diseases in Twins - pathology Diseases in Twins - therapy Female Fetal Growth Retardation - classification Fetal Growth Retardation - pathology Fetal Growth Retardation - therapy Humans Infant, Newborn Longitudinal Studies Pregnancy Pregnancy Outcome Prognosis Prospective Studies Twins, Monozygotic Ultrasonography, Prenatal Umbilical Arteries - diagnostic imaging Umbilical Cord - abnormalities Umbilical Cord - diagnostic imaging |
| title | Expectant management in type II selective intrauterine growth restriction and abnormal cord insertion in monochorionic twins |
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