Deepti Ghosh
Chittaranjan Seva Sadan College of Obstetrics, Gynaecology and Child Health, Kolkata, IndiaPresentation Title:
Optimizing delivery timing in selective fetal growth restricted dichorionic diamniotic twins: The critical role of doppler assessment
Abstract
Selective foetal growth restriction (sFGR) in dichorionic diamniotic (DCDA) twin pregnancies presents unique management challenges, particularly in assisted reproductive technology (ART) conceptions among women of advanced maternal age. This study analysed maternal and foetal outcomes in IVF-conceived DCDA twin pregnancies complicated by sFGR, emphasizing the critical role of Doppler assessment in guiding delivery timing decisions.
A retrospective case series of five IVF-conceived DCDA twin pregnancies complicated by sFGR in women aged 30-49 years was conducted at a tertiary care centre between August-October 2024. Foetal growth restriction was diagnosed using Delphi consensus criteria. All cases underwent comprehensive surveillance including serial ultrasound examinations with Doppler studies focusing on umbilical artery, middle cerebral artery, ductus venosus flow and cerebroplacental ratio (CPR) assessment. Multidisciplinary care with intensive monitoring protocols is essential for optimizing outcomes in these high-risk pregnancies.
Mean maternal age was 39.8 years, with 80% having advanced maternal age. All pregnancies demonstrated growth discordance ranging from 20-36%. Mean gestational age at delivery was 33+5 weeks (range: 32+2 to 36 weeks). Birth weights ranged from 1.01-2.50 kg. Delivery timing was primarily guided by Doppler deterioration, with 40% delivered before 34 weeks. Doppler findings revealed distinct patterns: normal indices despite sFGR (2/5 cases), progressive CPR deterioration (2/5 cases), and sequential umbilical artery changes from reduced to absent end-diastolic flow. CPR emerged as a valuable prognostic indicator, with values <1.5 correlating with adverse outcomes. Maternal complications included pregnancy-induced hypertension (20%), hypothyroidism (60%), and obstetric cholestasis (40%). Notable foetal outcomes included one Edwards syndrome, one intrauterine foetal death at 33 weeks 4 days, and neonatal complications due to prematurity.
Biography
Deepti Ghosh completed her MS degree in Obstetrics and Gynaecology from The Kalinga Institute of Medical Sciences, Bhubaneshwar, India, in 2025. At present, she is working as a Senior Resident in Chittaranjan Seva Sadan College of Obstetrics, Gynaecology and Child Health, Kolkata, India. As principal author, she has three publications in international journals and has participated in various OBGYN seminars and workshops in India.
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