Optimizing delivery timing in selective fetal growth restricted dichorionic diamniotic twins: lessons from a case series

Abstract

Authors aim to analyze the maternal and fetal outcomes in IVF -conceived dichorionic diamniotic (DCDA) twin pregnancies complicated by FGR in women of advanced maternal age, focusing on complications and management strategies. A retrospective analysis of five IVF-conceived DCDA twin pregnancies in women aged 30-49 years was conducted at our tertiary care center between August-October 2024. Establishment of presence of FGR in one or both twins, was done using Delphi criteria. Cases underwent systematic monitoring via serial ultrasound scans with Doppler and comprehensive maternal-fetal surveillance. The mean maternal age was 39.8 years, with a mean gestational age at delivery of 33+5 weeks.  All deliveries were performed via cesarean section and the notable complications included a case of Edwards syndrome diagnosed postnatally, and one intrauterine fetal death at 34 weeks in a severely growth-restricted fetus. Maternal complications included pre-eclampsia, hypothyroidism, and obstetric cholestasis. The birth weight was in a range of 1.01-2.48 kg.  The significant incidence of FGR and growth discordance in our cases emphasizes the need for regular fetal surveillance and Doppler studies in twin pregnancies. Our findings suggest that preventive cervical cerclage, timely antenatal corticosteroid administration, and appropriate timing of delivery are crucial elements in managing these pregnancies. The goals of management in these high-risk pregnancies are to optimize the time of delivery, minimize risks to both fetuses and balance risks of prematurity against risks of continued in-utero stay. Counselling the expecting couple is of paramount importance and due consideration should be given to maternal choice.