Type II and III Selective Fetal Growth Restriction: Perinatal Outcomes of Expectant Management and Laser Ablation of Placental Vessels.

OBJECTIVES: To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV). METHODS: Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate. RESULTS: The smaller fetus presented an absent/reversed "a" wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively. CONCLUSION: LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.

Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels

OBJECTIVES: To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV). METHODS: Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate. RESULTS: The smaller fetus presented an absent/reversed "a" wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively. CONCLUSION: LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.

Cord Occlusion in Monochorionic Twins with Early Selective Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler: A Consecutive Series of 90 Cases.

OBJECTIVE: To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III). METHODS: We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow. All cases presented at least one of the following severity criteria: gestational age (GA) <22 weeks, inter-twin estimated weight discordance >35%, reversed end-diastolic umbilical artery flow or ductus venosus pulsatility index >95th centile. We prospectively recorded pregnancy course and perinatal outcome. RESULTS: Median GA at surgery was 20.6 weeks and mean duration 22.4 min. Miscarriage (<24 weeks) occurred in 3.3% (3/90) and preterm delivery <32 weeks in 7.1% (6/84) of continuing pregnancies. GA at delivery was 36.4 weeks and neonatal survival of the larger twin was achieved in 93.3%. CONCLUSION: In a consecutive series studied by an experienced team, CO in monochorionic twins with severe sIUGR type II or III was associated with delivery >32 weeks in 92.9% and neonatal survival of the normal twin in 93.3% of pregnancies.

[Early severe restriction of intrauterine growth: a therapeutic alternative]. / Restricción del crecimiento intrauterino grave de inicio temprano: una alternativa terapéutica.

It is presented the case of the second pregnancy of a 36 year-old patient with antecedent of preeclampsia that was solved, at full-term, with a Caesarean operation by means of which was obtained a healthy new born. The patient began her prenatal control at 29th week. Ultrasound made at her admittance showed a fetus with an approximated weight of 451 grams. The patient was hospitalized until completing protocol of study for restriction of severe fetal growth. At 34.5 weeks, an ultrasonographical control showed an alteration in venous duct; for that reason it was decided to interrupt pregnancy abdominally. There were no surgical complications and was obtained a phenotypically normal new born, male, weight of 820 grams and size of 33 cm, who was referred to the Instituto Nacional de Perinatologia. At 43.3 weeks he was discharged from hospital with a weight of 1,840 grams. At the present he's fed with fortified milk.

Catch-up in body weight of intrauterine growth retarded (IUGR) rats castrated and treated with growth hormone.

The aim of the present study was to assess body weight recovery in rats with intrauterine growth retardation (IUGR) castrated and treated with growth hormone (GH). Wistar albino rats were divided into the following experimental groups: control (C), sham-operated (SH), IUGR, IUGR castrated (IUGR+C), and IUGR castrated and injected with GH (IUGR+C+GH). IUGR was induced by partial bending of uterine vessels at day 14 of pregnancy. GH (Genotropin 3.0 mg/kg/day) was administered from weaning (21 days old) to 60 days of age. SH rats were injected only with diluent. Castration was performed at weaning. Body weight, body weight velocity and relative food intake were registered weekly. Data were analyzed by ANOVA and LSD post hoc test. The between-subjects analysis showed significant differences for sex and treatment factors. Differences in body weight were significant among treatments, being SH > IUGR > IUGR+ C+GH > IUGR+C in males, and SH > IUGR+C > IUGR+C+GH > IUGR in females. Differences in relative food intake were IUGR+C > IUGR+C+GH > IUGR > SH in males, and IUGR+C+GH > IUGR+C > IUGR > SH in females. These results indicate that nutritional rehabilitation impairs the effects of IUGR. While the absence of testosterone inhibited body weight gain, the absence of estrogens promoted catch-up growth. Castrated animals with or without GH treatment ate relatively more, suggesting the absence of an anabolic effect of gonadal steroids.