Outcome of monochorionic diamniotic twin pregnancy with selective fetal growth restriction and continuous or intermittent absent or reversed end‐diastolic umbilical artery flow: international multicenter cohort study
Notice bibliographique
Résumé
OBJECTIVES: Monochorionic diamniotic (MCDA) twins with selective fetal growth restriction (sFGR) and either continuous (cAREDF) or intermittent (iAREDF) absent or reversed end-diastolic flow in the umbilical artery face significant fetal and neonatal risks. This study evaluated fetal and neonatal outcomes in these cases and compared outcomes for the larger twin following selective reduction (SR) vs expectant management (EM). METHODS: This was an international retrospective cohort study of MCDA twin pregnancies with sFGR and cAREDF or iAREDF from five fetal medicine centers over 7 years (2016-2022). Patients were included based on an estimated fetal weight (EFW) discordance of ≥ 20% combined with cAREDF or iAREDF. We collected demographic and antenatal characteristics, longitudinal ultrasound and management data, and key perinatal outcomes, including gestational age (GA) at birth, survival rate and severe neonatal morbidity. Outcomes for the larger twin following SR vs EM were compared using logistic regression with standardization, inverse probability weighting and augmented inverse probability weighting to adjust for confounders. Average treatment effects (risk differences) were calculated for three composite outcomes (live birth at ≥ 32 weeks; live birth at ≥ 32 weeks and absence of severe neonatal morbidity; and live birth without a GA limit and absence of severe neonatal morbidity) and overall live birth. RESULTS: Data were analyzed from 363 MCDA twin pregnancies (726 fetuses) with sFGR, which were diagnosed initially as having either cAREDF (n = 124) or iAREDF (n = 239). The umbilical artery flow pattern changed in 59% of pregnancies during gestation. Smaller twins with cAREDF at the final ultrasound scan before demise, delivery or intervention had a 70% survival rate, with 29% of survivors experiencing severe neonatal morbidity. In contrast, larger twins in this group had an 87% survival rate and a 26% risk of severe neonatal morbidity among survivors. For smaller twins with iAREDF at the final ultrasound scan, the survival rate was 83% and 22% of survivors were affected by severe neonatal morbidity, whereas larger twins had an 87% survival rate and a 13% risk of severe neonatal morbidity among survivors. The combined risk of adverse outcomes (fetal or neonatal demise or severe neonatal morbidity) was 52% for smaller twins with cAREDF and 37% for those with iAREDF. Among 37 cases of spontaneous fetal demise, 24 (65%) were double demise. Severe cerebral injury following single fetal demise occurred in approximately 30% of survivors. SR was associated with a 32-34% higher probability of the larger twin being liveborn ≥ 32 weeks compared with EM. This benefit seemed to align with later GA at birth and reduced rate of severe neonatal morbidity, despite similar rates of live birth. CONCLUSIONS: MCDA twins with sFGR and cAREDF or iAREDF are at high risk for demise and severe morbidity, particularly the smaller twin with cAREDF. Compared with EM, SR significantly improves the chance of the larger twin being born at ≥ 32 weeks and surviving without severe morbidity, which may be influenced by increased GA at birth. These data should inform patient counseling and management decisions. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».