OP16.08: Perinatal outcomes of monochorionic diamniotic twin pregnancies complicated by selective fetal growth restriction in a selected tertiary fetal care centre

To determine the perinatal outcome of sFGR in Monochorionic Diamniotic (MCDA) twin pregnancy defined as per Delphi consensus. This is a retrospective study of MCDA twin pregnancies with selective fetal growth restriction (sFGR) from 2010-2023 at a tertiary fetal centre. sFGR according to Delphi consensus criteria is Estimated Fetal Weight (EFW)< 5th centile in one twin or at least two of the following criteria's which is EFW of one twin < 10th centile, abdominal circumference of one twin < 10th centile, EFW discordance ≥ 25% or Umbilical Artery(UA)PI of smaller twin >95th centile. These criteria were retrospectively applied to the data that was collected in the pregnancies. All sFGR fetuses were already classified into 3 types as per the UA Doppler flow pattern. Type1 had positive EDF, Type2 had persistently absent/reversed EDF and Type3 had intermittent present, absent and reversed EDF in the UA. The primary outcomes were double survivors, single survivors and double loss. Of 416 MCDA twin pregnancies,146(35.1%) pregnancies were diagnosed with sFGR without other complications of monochorionicity. Based on the UA Doppler pattern, the sFGR twin, were classified into 118/146(80.8%) in type 1,11(7.5%) in type 2 and 17(11.6%) in type 3.10 pregnancies(7 in type1 and 3 in type2) that terminated were excluded from further analyses. In the 111 pregnancies complicated by sFGR Type1,double live births (LB) occurred in 76(68.5%), single LB in 21(18.9%) and double fetal loss(FL) in 14(12.6%). In the 8 pregnancies complicated by sFGR Type 2, double LB in 3 (37.5%), single LB in 3 (37.5%) and double FL in 2 (25%). In the 17 pregnancies complicated by sFGR Type 3, double LB in 9 (52.9%), single LB in 6 (35.3%) and double FL in 2 (11.8%). In our cohort, type1 sFGR had a higher incidence of double LB, followed by type 3 sFGR. Type 2 had the highest double FL rate. Our study confirms the significance of UA Doppler assessment of sFGR in MCDA twin pregnancies providing valuable insights for predicting outcomes and guiding clinicians in making informed decisions.