Monitoring was similar for twins and singletons suspected to be SGA. Because of their specific complications, monochorionic twin pregnancies were excluded, as were multiple pregnancies that resulted in a twin pregnancy after embryo reduction. Cases were also excluded from the analysis when SGA status was associated with a malformation, a karyotype anomaly, fetomaternal infection, fetomaternal alloimmunization, or premature rupture of the membranes before 24 weeks. We excluded fetuses with a birth weight above the 10 th percentile. It was defined as severe if the AC was below the 3 rd percentile and moderate if between the 3 rd and 10 th percentiles. SGA status was defined by at least one ultrasound AC measurement at or below the 10 th percentile according to the fetal biometry curves used in our maternity ward. To verify the inclusion and exclusion criteria, we examined the case records of all fetuses who had a measurement at or below the 10 th percentile according to the curves of the French College of Fetal Echography used by DIAMM software, for any relevant biometric indicator (biparietal diameter, head circumference, abdominal circumference (AC), or femur length) and all children with a birth weight at or below the 10 th percentile according to the curves of Leroy and Lefort. The guidelines in our department are based on Clinical Practice Guidelines issued by the French College of Gynecologists and Obstetricians (CNGOF,, see The cases were identified with DIAMM software (MICRO6 SARL, version 7.3.7 Rev2, Villiers Les Nancy, France) from a prospectively collected and recorded database of information about all pregnancies in our hospital. A longer period was chosen for recruitment of twins in view of the lower incidence of twin pregnancies. The group of singletons included all fetuses in singleton pregnancies prenatally diagnosed as SGA born between January 1, 2008, and December 31, 2009. When both twins from the same pregnancy were diagnosed as SGA, both were included. The group of twins included all fetuses in twin pregnancies prenatally diagnosed as SGA born between January 1, 2007, and December 31, 2010. This retrospective study was conducted in a level 3 maternity unit in France. ![]() We compared the prognostic value of fetal Doppler in SGA dichorionic twins and singletons by measuring the time interval between an abnormal Doppler finding and birth. If so, their use in monitoring and making medical decisions should be adapted to this particular population of twins. It is therefore possible that the prognostic value of fetal Doppler examinations differs from that observed in singletons. The pathophysiology of abnormal growth in twins, however, may differ from that in singletons and may be related to abnormalities of blood flow distribution and of placentation. In view of its elevated prognostic value in singletons, fetal Doppler is recommended in monitoring and deciding on delivery in these cases. Data are sparse about the prognostic value of fetal Doppler when one or both twins are SGA. ![]() Twins are more frequently SGA than singletons. ![]() ![]() In particular, fetal Doppler has proved its value in monitoring these fetuses and plays an important role in decisions about early delivery. Monitoring procedures in these cases are relatively consensual, as are the factors used to decide upon early intervention for delivery: fetal heart rate (FHR) abnormalities, arrested growth, estimated fetal weight, and Doppler flow abnormalities. Many studies have examined the pathophysiology and outcome of singletons born small for gestational age (SGA) due to vascular causes.
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