Selective Fetal Growth Restriction: Parts of Pathogenesis

Monochorionic diamniotic twin gestations have a higher risk of perinatal complications than both dichorionic twins and singleton pregnancies. One of the complications of multiple pregnancies is selective fetal growth restriction (sFGR), the incidence of which varies from 10 to 25%. sFGR is a condition of twin pregnancy in which the development of one fetus is restricted, despite normal growth of the other fetus; one of the fetuses is supplied with insufficient nutrient and oxygen content through the placenta to grow at a normal rate. The pathogenesis of sFGR has a multifactorial nature, including disorders of trophoblast invasion, vasculo- and angiogenesis, gestational formation of the placenta with discordant separation of intertwin territories and unbalanced blood flow through interfetal anastomoses oxidative stress, growth factor imbalance, and changes in the metabolomic profile of cord blood and placental tissue. The prenatal diagnosis of sFGR is sometimes problematic and it is not possible to find all the cases. A more detailed study of the various predictors of the occurrence of sFGR will allow the discovery of new markers that will help in early diagnosis, determining the optimal management for pregnancy and predicting perinatal outcome.