Selective Intrauterine Growth Restriction (sIUGR)

Selective Intrauterine Growth Restriction (sIUGR)

  • Overview
  • Approach
  • Causes & Types
  • Appointments
  • Diagnosis
  • Treatment
  • Locations
  • Doctors

    • What is Selective Intrauterine growth restriction (sIUGR)?

    sIUGR affects 10–15% of monochorionic diamniotic twin pregnancies and has several additional possible causes in these types of twins. The most common cause is unequal placental sharing. In addition to a fetal anomaly or velamentous cord insertion, unequal distribution of cells when the identical twins initially split are an additional cause. There are three subtypes of monochorionic sIUGR pregnancies that have been described. These pregnancies are at increased risk of twin-to-twin transfusion syndrome.

    For both dichorionic and monochorionic twins, the prognosis is determined by the degree of discordance and the presence or absence of abnormalities in the blood flow to the fetuses or within blood vessels in the fetus (Doppler measurements) as this will predict the gestational age at delivery. All twin pregnancies are at increased risk of preterm birth and for stillbirth or intrauterine fetal demise. Due to these risks, they require very close surveillance. They may benefit from frequent monitoring, including ultrasounds and prenatal testing to assess prognosis and optimize the timing of delivery. For some cases of sIUGR, there may be a role for fetal interventions.

    Our Approach

    The University of Michigan Health's Fetal Diagnosis & Treatment Center has extensive experience caring for all types of multiple gestations. Our maternal fetal medicine physicians provide the highest level of prenatal assessment and delivery planning and our neonatology physicians provide neonatal intensive care for those pregnancies that do require preterm delivery.

    What causes sIUGR in twins? 

    sIUGR can affect dichorionic (separate placentas and amniotic sacs) or monochorionic (a single, shared placenta) twin gestations but is more common in monochorionic twins. For both monochorionic and dichorionic twins, it can be associated with a fetal anomaly in one twin or a velamentous cord insertion (where the umbilical cord inserts into the membranes instead of directly into the placenta). For dichorionic twins, it can also be due to one twin having a better location for the placental implantation.

    What are the types of sIUGR?

    sIUGR is divided into three separate types, based on blood flow in the umbilical artery as measured by Doppler ultrasound. A given pregnancy may shift from one type to another during the pregnancy.

    • Type 1 – consistent forward flow in the umbilical artery Dopplers. This has the best prognosis and is associated with the highest gestational age at delivery.
    • Type 2 – absent or reverse flow noted in the umbilical artery Dopplers for the IUGR fetus.
    • Type 3 – intermittent absent or reverse flow noted in the umbilical artery Dopplers for the sIUGR fetus. This is unpredictable and is associated with a higher rate of neuroimpairment.

     

    Appointment Information

    To make an appointment, please call 734-763-6295.

    How is sIUGR diagnosed?

    The diagnosis is made by ultrasound using an estimate of the fetal weight or the size of the abdomen to determine if one of the fetuses is smaller than expected. Ultrasound is usually recommended to be done regularly during a twin pregnancy to assess for this condition.

    How is sIUGR treated?

    Unfortunately, there is no treatment to improve growth or to prevent the development of sIUGR. Making the diagnosis allows potential treatments to improve the outcomes if early delivery is required and also allows optimization of the timing of the delivery.

    Locations
    • Fetal Diagnosis and Treatment Center | Von Voigtlander Women's Hospital 1540 E Hospital Dr
      Floor 9
      Ann Arbor, MI 48109-4264       Get Directions

    Doctors

     Search for a U-M Health doctor

    Deborah Rose Berman, MD

    Clinical Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

    Mark Christopher Chames, MD

    Clinical Associate Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

    Joseph Thomas Church, MD

    Joseph Thomas Church, MD

    Clinical Assistant Professor

    Pediatric Surgery, Surgery

    Caitlin Madden Clifford, MD

    Caitlin Madden Clifford, MD

    Clinical Assistant Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

    Sarah Marie Davis, MD

    Sarah Marie Davis, MD

    Clinical Associate Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

    Patricia Stephanie Greco, MD

    Patricia Stephanie Greco, MD

    Clinical Assistant Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

    Elizabeth Suzanne Langen MD

    Elizabeth Suzanne Langen, MD

    Clinical Associate Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

    George B Mychaliska, MD, MS

    George Boris Mychaliska, MD

    Professor

    Pediatric Surgery, Surgery

    Erin Elizabeth Perrone, MD

    Erin Elizabeth Perrone, MD

    Clinical Associate Professor

    Pediatric Surgery, Surgery

    Molly Jean Stout MD, MSCI

    Molly Jean Stout, MD, MS

    Associate Professor

    Maternal & Fetal Medicine, Obstetrics & Gynecology

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