Fetal growth restriction in twins

Twin pregnancies are more likely to be affected by fetal growth restriction (FGR), preterm birth and perinatal loss. The management of fetal growth restriction in multiple pregnancy, particularly where only one fetus is affected is complicated by the need to consider the interests of both twins. Selective growth restriction in monochorionic (MC) twins is a pathophysiological process distinct from FGR in dichorionic (DC) pregnancies and management demands an understanding of the monochorionic placental structure and interdependent fetal circulations. The introduction of fetal therapy has introduced a range of potential interventions for the antenatal management of sFGR including selective fetal reduction and laser photocoagulation of the placental communicating vessels. This review summarizes up to date evidence on diagnosis, classification and management of sFGR and considers research directions likely to be of benefit in the future.