Smriti Prasad, Asma Khalil, Jamie J. Kirkham, Andrew Sharp, Kerry Woolfall, Tracy Karen Mitchell, Odai Yaghi, Tracey Ricketts, Mariana Popa, Zarko Alfirevic, Dilly Anumba, Richard Ashcroft, George Attilakos, Carolyn Bailie, Ahmet A. Baschat, Christine Cornforth, Fabricio Da Silva Costa, Mark Denbow, Jan Deprest, Natasha Fenwick, Monique C. Haak, Louise Hardman, Jane Harrold, Andy Healey, Kurt Hecher, Rajeswari Parasuraman, Lawrence Impey, Richard Jackson, Edward Johnstone, Shauna Leven, Liesbeth Lewi, Enrico Lopriore, Isabella Oconnor, Danielle Harding, Joel Marsden, Jessica Mendoza, Tommy Mousa, Surabhi Nanda, Aris T. Papageorghiou, Dharmintra Pasupathy, Jane Sandall, Shakila Thangaratinam, Baskaran Thilaganathan, Mark Turner, Brigitte Vollmer, Michelle Watson, Karen Wilding, Yoav Yinon, FERN Study Team
{"title":"Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey","authors":"Smriti Prasad, Asma Khalil, Jamie J. Kirkham, Andrew Sharp, Kerry Woolfall, Tracy Karen Mitchell, Odai Yaghi, Tracey Ricketts, Mariana Popa, Zarko Alfirevic, Dilly Anumba, Richard Ashcroft, George Attilakos, Carolyn Bailie, Ahmet A. Baschat, Christine Cornforth, Fabricio Da Silva Costa, Mark Denbow, Jan Deprest, Natasha Fenwick, Monique C. Haak, Louise Hardman, Jane Harrold, Andy Healey, Kurt Hecher, Rajeswari Parasuraman, Lawrence Impey, Richard Jackson, Edward Johnstone, Shauna Leven, Liesbeth Lewi, Enrico Lopriore, Isabella Oconnor, Danielle Harding, Joel Marsden, Jessica Mendoza, Tommy Mousa, Surabhi Nanda, Aris T. Papageorghiou, Dharmintra Pasupathy, Jane Sandall, Shakila Thangaratinam, Baskaran Thilaganathan, Mark Turner, Brigitte Vollmer, Michelle Watson, Karen Wilding, Yoav Yinon, FERN Study Team","doi":"10.1111/1471-0528.17891","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.</p>\n </section>\n \n <section>\n \n <h3> Design</h3>\n \n <p>Cross-sectional survey.</p>\n </section>\n \n <section>\n \n <h3> Setting</h3>\n \n <p>International.</p>\n </section>\n \n <section>\n \n <h3> Population</h3>\n \n <p>Clinicians involved in the management of MCDA twin pregnancies with sFGR.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A structured, self-administered survey.</p>\n </section>\n \n <section>\n \n <h3> Main Outcome Measures</h3>\n \n <p>Clinical practices and attitudes to diagnostic criteria and management strategies.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management.</p>\n </section>\n </div>","PeriodicalId":4,"journal":{"name":"ACS Applied Energy Materials","volume":null,"pages":null},"PeriodicalIF":5.4000,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17891","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Energy Materials","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/1471-0528.17891","RegionNum":3,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CHEMISTRY, PHYSICAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.
Design
Cross-sectional survey.
Setting
International.
Population
Clinicians involved in the management of MCDA twin pregnancies with sFGR.
Methods
A structured, self-administered survey.
Main Outcome Measures
Clinical practices and attitudes to diagnostic criteria and management strategies.
Results
Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide.
Conclusions
There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management.
目的确定目前处理单绒毛膜双胎妊娠选择性胎儿生长受限（sFGR）的方法：设计：横断面调查：调查对象方法：结构化自填式调查：主要结果测量：临床实践以及对诊断标准和管理策略的态度：总体而言，62.8%（113/180）的临床医生完成了调查；其中，66.4%（75/113）的受访者表示他们会使用估计胎儿体重（EFW）为 25% 的标准来诊断 sFGR。对于早发的 I 型 sFGR，79.8%（75/94）的受访者表示他们的常规做法是进行预期管理。另一方面，對於早期發病的 II 型及 III 型 sFGR，分別有 19.3%（17/88）及 35.7%（30/84）的受訪者會在懷孕期間進行處理，而 71.6%（63/88）及 57.1%（48/84）的受訪者會將這些妊娠轉介至胎兒介入中心，或為 II 型及 III 型個案提供胎兒介入服務。此外，39.0%（16/41）的受訪者會考慮為早期發病的 I 型 sFGR 進行胎兒內視鏡激光手術（FLS），而 41.5%（17/41）的受訪者會提供胎兒內視鏡激光手術或選擇性胎死腹中，12.2%（5/41）的受訪者只會提供選擇性胎死腹中。对于早发的Ⅱ型和Ⅲ型sFGR病例，分别有25.9%（21/81）和31.4%（22/70）的人只会提供FLS，而33.3%（27/81）和32.9%（23/70）的人只会提供选择性胎死宫内术：结论：临床医生对 MCDA 双胎妊娠中早发 sFGR 的处理方法和态度存在很大差异，尤其是对 II 型和 III 型病例，这突出表明需要高水平的证据来指导处理方法。
期刊介绍：
ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.
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