Looking at treatment choices for early selective fetal growth restriction in monochorionic twin pregnancy
FERN is a UK study taking place in multiple hospitals. It looks at selective fetal growth restriction, also called sFGR or sIUGR, in monochorionic twin pregnancies where both babies share one placenta.
The study looks at what happens when sFGR is managed in different ways. This includes having an intervention or being monitored without any other treatment.
Monochorionic twin pregnancies that develop sFGR can have poor outcomes for babies. There isn’t enough evidence to guide treatment, especially when sFGR begins before 24 weeks of pregnancy.
What the study is trying to find out
The FERN study is exploring whether it’s possible to run a trial. This would compare different treatments with monitoring without treatment in monochorionic twins diagnosed with sFGR.
It also considers:
- what parents prefer
- what doctors prefer
- ethical dilemmas
- current UK practice
- how many cases happen each year
- what research already tells us about sFGR
- what’s needed to design a future trial
How the study is set up
Work package one uses learning from a recent survey of current practice and the Twin-to-Twin Transfusion Syndrome (TTTS) registry.
It collects data on management and outcomes for monochorionic twin pregnancies with sFGR. It includes 103 women whose pregnancy was identified with sFGR before 24 weeks, across 23 UK fetal medicine units.
The team is looking at what doctors currently do and how this affects babies. This will help build a clearer picture of how and when sFGR develops, what treatments are used and what happens after treatment.
Work package two involves interviews and focus groups. It includes 25 parents and 25 doctors.
It explores views on the proposed trial, including ethical concerns and concerns about the trial design. This information will help shape work package three.
Work package three uses findings from work packages one and two to decide how, and if, a trial should run.
The team will use a Delphi method. This is a structured way to reach agreement, involving parents, doctors, funders and relevant charities. If the decision is to go ahead, the team can then design the trial and apply for funding.
Who’s running and funding the study
Professor Asma Khalil runs this study through the Harris Wellbeing of Women Research Centre at the University of Liverpool. It’s funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA).
Contact the study team
For more information, you can contact the FERN Study Management Team:
email: fern1@liverpool.ac.uk
tel: 0151 795 9562
Don’t miss what matters
Get Twins Trust news, support updates and practical resources—straight to your inbox.
Publications linked to the FERN study
For further information on findings of the FERN study, please see the publications below:
- Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey
- Balancing key stakeholder priorities and ethical principles to design a trial comparing intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy
- Is it possible to conduct a randomised controlled trial of intervention or expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy? - Protocol for a prospective multicentre mixed-methods feasibility study
- Ethical considerations of a randomised controlled trial of fetal intervention versus expectant management in monochorionic twin pregnancies with early-onset selective fetal growth restriction
- Feasibility and acceptability of randomized controlled trial of intervention vs expectant management for early-onset selective fetal growth restriction in monochorionic twin pregnancy
Published