{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:57:57Z","timestamp":1790351877214,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,2,5]],"date-time":"2019-02-05T00:00:00Z","timestamp":1549324800000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify key factors associated with adverse perinatal outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction (sFGR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of all monochorionic diamniotic twin pregnancies diagnosed with sFGR at \u2265\u200916\u2009weeks' gestation, in a single tertiary referral center between March 2000 and May 2015. The presence of coexisting twin\u2013twin transfusion syndrome (TTTS) was noted. Fetal biometry and Doppler indices, including those of the umbilical artery (UA) and ductus venosus (DV), were recorded at the time of diagnosis. The type of sFGR was diagnosed according to the pattern of end\u2010diastolic flow in the UA of the smaller twin. DV pulsatility indices for veins (DV\u2010PIV) were converted to <jats:italic>Z<\/jats:italic>\u2010scores and estimated fetal weight values to centiles, to correct for gestational age (GA). Cox proportional hazards model was used to examine for independent predictors of adverse perinatal outcome, which was defined according to survival and included both intrauterine fetal demise and neonatal death of the FGR twin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We analyzed 104 pregnancies, of which 66 (63.5%) were diagnosed with Type\u2010I and 38 (36.5%) with Type\u2010II sFGR at initial presentation. In pregnancies complicated by Type\u2010II sFGR, the diagnosis of sFGR was made earlier than in those complicated by Type\u2010I sFGR (mediam GA, 19.6 <jats:italic>vs<\/jats:italic> 21.5\u2009weeks; <jats:italic>P<\/jats:italic>\u2009=\u20090.012), and Type\u2010II sFGR was associated with increased risk of adverse perinatal outcome (intrauterine demise of the smaller twin, 34.2% <jats:italic>vs<\/jats:italic> 10.6%; <jats:italic>P<\/jats:italic>\u00a0=\u20090.004). Twin pregnancies complicated by sFGR resulting in perinatal demise had a significantly earlier diagnosis (<jats:italic>P<\/jats:italic>\u00a0=\u20090.002) and lower birth\u2010weight centile of the smaller twin (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01), those with Type\u2010I sFGR had earlier GA at delivery  (<jats:italic>P<\/jats:italic>\u2009=\u20090.007) and those with Type\u2010II sFGR had higher DV\u2010PIV <jats:italic>Z<\/jats:italic>\u2010score of the smaller twin (<jats:italic>P<\/jats:italic>\u2009=\u20090.003), when compared with pregnancies resulting in live birth. Coexisting TTTS had no significant impact on the perinatal outcome of pregnancies diagnosed with either Type\u2010I or Type\u2010II sFGR (<jats:italic>P<\/jats:italic>\u00a0&gt;\u20090.05 for both). Earlier GA at diagnosis (hazard ratio (HR), 0.70 (95% CI, 0.56\u20130.88); <jats:italic>P<\/jats:italic>\u00a0=\u20090.002), Type\u2010II sFGR (HR, 3.53 (95% CI, 1.37\u20139.07); <jats:italic>P<\/jats:italic>\u00a0=\u20090.008) and higher DV\u2010PIV <jats:italic>Z<\/jats:italic>\u2010score (HR, 1.36 (95% CI, 1.12\u20131.65); <jats:italic>P<\/jats:italic>\u00a0=\u20090.001) were significantly associated with increased risk of adverse perinatal outcome of the smaller twin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pregnancies complicated by Type\u2010II sFGR are diagnosed significantly earlier and are associated with increased risk of adverse perinatal outcome compared with those with Type\u2010I sFGR. Coexisting TTTS has no significant impact on the perinatal outcome of pregnancies diagnosed with either Type\u2010I or Type\u2010II sFGR. Earlier GA at diagnosis, Type\u2010II sFGR and higher DV\u2010PIV <jats:italic>Z<\/jats:italic>\u2010score are associated significantly with increased risk of adverse perinatal outcome of the smaller twin. Copyright \u00a9 2018 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.19078","type":"journal-article","created":{"date-parts":[[2018,4,28]],"date-time":"2018-04-28T07:35:17Z","timestamp":1524900917000},"page":"200-207","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Prediction of adverse pregnancy outcome in monochorionic diamniotic twin pregnancy complicated by selective fetal growth restriction"],"prefix":"10.1002","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8453-1375","authenticated-orcid":false,"given":"C.","family":"Monaghan","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Kalafat","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Ankara University, Faculty of Medicine, Department of Obstetrics and Gynecology  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5725-9270","authenticated-orcid":false,"given":"J.","family":"Binder","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5531-4301","authenticated-orcid":false,"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London  London 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