Perinatal outcomes of monochorionic multiple pregnancies with selective intrauterine growth restriction


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Abstract

Monochorionic multiple pregnancy is associated with a high risk for perinatal morbidity and mortality. Perinatal loss may be frequently caused by selective intrauterine growth restriction (sIUGR) of one fetus. Objective. To assess perinatal outcomes of monochorionic multiple pregnancy complicated by selective intrauterine growth restriction of one fetus. Materials and methods. A retrospective study included 196 monochorionic pregnancies and neonatal outcomes of 376 infants. The cases were divided into two groups: the main group consisted of pregnancies with sIUGR and the control group included uncomplicated twin pregnancies. The main group was divided into subgroups according to the classification of sIUGR. Antenatal period and neonatal outcomes were compared in groups and subgroups. The D’Agostino-Pearson test, Mann-Whitney U test, and Kruskal-Wallis test were used for statistical data processing. The differences were considered significant atp<0.05. Results. Type I sIUGR was revealed in 69.8% of pregnant women, type II sIUGR - in 20.8% and type III sIUGR - in 9.4% of women. The highest weight discordance was 51% and was detected in type II subgroup, the lowest discordance was noted in type III which was 26.3% (р<0.001). Antenatal mortality in group with sIUGR was 12.5%, its highest rate was revealed in type III subgroup (44.4%). Gestational age at delivery for sIUGR pregnancies was 33.1 weeks. Earlier delivery occurred in type II and III subgroups, at 31 and 30.7 weeks’ gestation, respectively. The weight of infants with sIUGR was significantly less than one in uncomplicated pregnancies. The incidence of neurological disorders was increased in group with sIUGR (24.3%) and it was the highest in type III subgroup (58.3%). Early neonatal death occurred only in the group with sIUGR (7.9%) and was predominant in type II subgroup (28.6%). Conclusion. Monochorionic twin pregnancy complicated by sIUGR is associated with a high risk for antenatal fetal death, as well as morbidity and mortality of infants. sIUGR type is an important factor which determines pregnancy outcome and neonatal period.

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About the authors

Kirill V. Kostyukov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: kostyukov_k@yahoo.com
MD, PhD, Department of the Functional Diagnosis

Kristina A. Gladkova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: k_gladkova@oparina4.ru
MD, PhD, research fellow, Obstetrics Pathology Department

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