Congenital heart defects in monochorionic twin pregnancy complicated by selective fetal growth restriction

Autor: S. Faiola, D. Casati, L. Nelva Stellio, A. Laoreti, C. Corti, S. Mannarino, M. Lanna, I. Cetin
Rok vydání: 2023
Předmět:
Zdroj: Ultrasound in Obstetrics & Gynecology. 61:504-510
ISSN: 1469-0705
0960-7692
DOI: 10.1002/uog.26098
Popis: To evaluate the prevalence, types, and postnatal follow-up of congenital heart defects (CHDs) in a cohort of monochorionic (MC)/diamniotic (DA) twin pregnancies complicated by selective fetal growth restriction (sFGR) and to compare this population with an uncomplicated MC/DA population evaluated during the same period.We retrospectively analyzed all consecutive MC/DA pregnancies from 2009 to 2018, including those complicated by sFGR (group A) and uncomplicated (group B) cases. All inborns were screened for CHD before discharge. Discharge letters for all outborns were retrieved. Pregnancies with complications other than sFGR, or those without perinatal follow-up were excluded. The MC cases in group A were further divided into three types of sFGR according to the Gratacos classification.In total, 870 MC/DA twin pregnancies formed the study population: 296 in group A and 574 in group B. In group A, the CHD prevalence was 3.7% (22 of 592 twins), without significant differences between the three types of sFGR (type 1, 3.6%; type 2, 3.2%; type 3, 4.1%; p=0.55). Out of the five CHD in type 3 pregnancies, we had one case of pulmonary stenosis (PS) in the larger twin, with an isolated coarctation of the aorta in the smaller co-twin, while in other three cases with CHD, only PS was observed in the larger twins. Type 3 pregnancies in which only the smaller twin was affected by CHD was not observed in this study. In the larger twins, 10 of 11 CHD cases (91%) were right ventricular outflow tract abnormalities (RVOTA), and 1 (9%) was a ventricular septal defect. In the smaller twins, we identified 11 cases of CHD with a broad spectrum of cardiac abnormalities. In group B, the CHD prevalence was 1.1% (13 of 1148 twins), which was similar to the CHD prevalence in the general population according to the EUROCAT registry for the same years and geographical area of the study (0.96%; p=0.579). The CHD prevalence was significantly higher in group A than in group B [3.7% versus 1.1%; p=0.0002; odds ratio=3.57 (95% confidence interval: 1.78-7.22)]. In all group A and group B pregnancies, CHDs were discordant anomalies.In our experience, in MC/DA twin pregnancies, sFGR tripled the prevalence of CHD; hence, women with such pregnancies should be referred to a tertiary care hospital for prenatal and postnatal cardiac evaluation, treatment, and long-term follow-up. In the larger twins, the only major CHD was RVOTA, while a broad spectrum of CHDs was involved in the smaller twins. The higher risk of CHD in MC/DA pregnancies appears to be due to the typical complications of the MC pregnancy rather than to the MC nature of the pregnancy itself. This article is protected by copyright. All rights reserved.
Databáze: OpenAIRE
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