{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T20:25:31Z","timestamp":1789244731657,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Monochorionic diamniotic twin pregnancies complicated by Type\u2010III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was an international multicenter retrospective cohort study. Type\u2010III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10<jats:sup>th<\/jats:sup> percentile and intertwin EFW discordance of \u2265\u200925% in combination with intermittent absent or reversed end\u2010diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (<jats:italic>n<\/jats:italic>\u2009=\u200919 (6.2%)) or double (<jats:italic>n<\/jats:italic>\u2009=\u200916 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type\u2010III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32\u2009weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low\u2010risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate\u2010risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16\u2009+\u20095\u2009weeks' gestation; and a high\u2010risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was &lt;\u200916\u2009+\u20095\u2009weeks' gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Type\u2010III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest\u2010risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort. \u00a9 2022 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.24896","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T11:10:46Z","timestamp":1646737846000},"page":"756-762","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Prediction of fetal death in monochorionic twin pregnancies complicated by <scp>Type\u2010III<\/scp> selective fetal growth restriction"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3034-6905","authenticated-orcid":false,"given":"T.","family":"Van Mieghem","sequence":"first","affiliation":[{"name":"Ontario Fetal Centre, Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-5778","authenticated-orcid":false,"given":"L.","family":"Lewi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Slaghekke","sequence":"additional","affiliation":[{"name":"Department of Gynecology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0702-370X","authenticated-orcid":false,"given":"Y.","family":"Yinon","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3957-3810","authenticated-orcid":false,"given":"L.","family":"Raio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Inselspital, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9914-6496","authenticated-orcid":false,"given":"D.","family":"Baud","sequence":"additional","affiliation":[{"name":"Department Woman\u2010Mother\u2010Child Lausanne University Hospital  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Dekoninck","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Erasmus MC University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2704-1385","authenticated-orcid":false,"given":"N.","family":"Melamed","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2013Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Huszti","sequence":"additional","affiliation":[{"name":"Biostatistics Research Unit University Health Network  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8467-0383","authenticated-orcid":false,"given":"L.","family":"Sun","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit &amp; 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