Selective Fetal Growth Restriction in Monochorionic Twin Pregnancy: A Review of Current Literature on Diagnostic and Therapeutic Updates

Monochorionicity refers to the condition in which twins share a single placenta. Selective fetal growth restriction (sFGR) in monochorionic (MC) twin pregnancy poses significant challenges due to its association with high risks of perinatal mortality and morbidity. Managing sFGR poses a particular challenge, as affected pregnancies require more frequent monitoring compared to uncomplicated singleton or twin pregnancies. Expectant management is typically applied for type I cases, which generally have favorable outcomes. In contrast, more severe cases (type II and III) may require invasive management, such as fetoscopic laser photocoagulation (FLP) or selective termination. However, how to best manage this complicated pregnancy remains debated, as no evidence-based guidance is currently available. This review aims to summarize the underlying pathophysiology, various diagnostic criteria, classification systems, and current management strategies for sFGR. These include the perinatal outcomes associated with expectant and invasive management in sFGR.