Outcomes of Selective Fetal Growth Restriction in Monochorionic Pregnancies at Monash Health

Selective fetal growth restriction (sFGR) is a relatively common complication of monochorionic twin pregnancies in which there is significant inter-twin size discordance and one of the twins is growth restricted, often with abnormal Doppler studies (sFGR types 2 and 3) at pre-viable gestational ages. In cases of demise of the growth restricted twin, death or brain injury of the well grown twin may occur in 20-30% of the cases. While fetoscopic laser ablation of placental anastomosis is highly effective in the treatment of twin-to-twin transfusion syndrome, its benefit in protecting the well-grown twin and improving pregnancy outcomes of pregnancies complicated by sFGR remains unclear. In this project, we will retrospectively review all cases of sFGR sequence seen by the Victorian Fetal Therapy Service (VFTS) at Monash Health to characterise the management and the outcomes with intervention or expectant management, and the utility of laser surgery in sFGR (in particular type 2).