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Pregnancy management after diagnosis of type 2 and type 3 sFGR

Pregnancy management after diagnosis of type 2 and type 3 sFGR
Type 2 sFGR is characterized by fixed absent or fixed reversed UA end-diastolic velocity without variation of the waveform in the smaller twin; type 3 sFGR is characterized by variable flow pattern that cycles between forward, absent, and reversed flow over a short interval (ie, intermittent absent/reversed end-diastolic flow).

DV: ductus venosus; MCA: middle cerebral artery; NST: nonstress test; PI: pulsatility index; sFGR: selective fetal growth restriction; UA: umbilical artery.

* Signs of worsening disease include progression from type 2 to type 3 sFGR, DV PI >95th percentile, development of absent or reversed a-wave in the DV waveform, and oligohydramnios in the sac of the smaller twin.

¶ Deliver sFGR pregnancies with UA reversed end-diastolic flow at 30+0 to 32+0 weeks and those with UA absent end-diastolic flow at 32+0 to 34+0 weeks, in the absence of complications necessitating earlier delivery.
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