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Case Report
A case of type III selective intrauterine growth restriction in a monochorionic twin pregnancy with a myriad of Doppler changes of the umbilical and vitelline arteries
1 Intern at Tony Tan Women and Fetal Clinic, Mount Alvernia Hospital, Singapore
2 MBBS (Singapore), MMED (O&G, Singapore), MRANZCOG (Australia, New Zealand), FRCOG (UK), FAMS (Singapore), Consultant Obstetrician and Gynecologist, Tony Tan Women and Fetal Clinic, Mount Alvernia Hospital, Singapore
3 MBBS (Singapore), MMED (Paed) (Singapore), MRCP (Paed) (UK), Consultant Pediatrician and Neonatologist, Kinder Clinic, Mount Alvernia Hospital, Singapore
Address correspondence to:
Tan Tony Yew Teck
820 Thomson Road, Mount Alvernia Hospital, #07-66 Medical Centre D, Singapore 574623,
Singapore
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Article ID: 100144Z08DG2023
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How to cite this article
Ghosh D, Tan TYT, Tan THM. A case of type III selective intrauterine growth restriction in a monochorionic twin pregnancy with a myriad of Doppler changes of the umbilical and vitelline arteries. J Case Rep Images Obstet Gynecol 2023;9(1):44–48.ABSTRACT
Monochorionic twins have higher mortality rates than dichorionic twins. Selective intrauterine growth restriction (sIUGR) is a common complication found in monochorionic twins. We report such a case of type III sIUGR monochorionic twins. There was positive end-diastolic flow of umbilical arteries, which corresponded to type I sIUGR at 15 weeks. Then, the umbilical arteries showed persistently absent end-diastolic flow at 17 weeks which corresponded to type II sIUGR. Finally, the umbilical artery showed intermittent absent/reversed end-diastolic flow which corresponded to type III sIUGR. This case demonstrated a unique myriad of Doppler changes during the pregnancy, indicating its significance in being reported. The twins were delivered by caesarean section at 32 weeks and were developing well. Placental examination showed unequal placental sharing and the presence of an arterio-arterial anastomosis. These are characteristic findings of a type III sIUGR. Type III sIUGR may not be obvious at the initial examination but may only be obvious at later examinations.
Keywords: Doppler changes, Monochorionic, sIUGR, Type III
SUPPORTING INFORMATION
Author Contributions
Debora Ghosh - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tan Tony Yew Teck - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tan Terence Hwa Min - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Debora Ghosh et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
