Purpose Of Review: The aim of this article is to review the prenatal diagnosis and treatment of complicated monochorionic twins, with emphasis on surgical management via operative fetoscopy.
Recent Findings: Ultrasound is effective in the diagnosis and surveillance of several conditions that complicate monochorionic twins, such as twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, selective intrauterine growth restriction, and discordant anomalous twins. Ultrasound is also useful in identifying risk factors for poor perinatal outcomes and identifying those pregnancies that may benefit from fetal intervention. Operative fetoscopy has emerged as a useful tool in the surgical management of complicated monochorionic twins. Recent findings support the use of laser therapy for the treatment of mid-trimester twin-twin transfusion syndrome at experienced centers. The reduction in hemodynamic stress associated with definitive treatment of twin-twin transfusion syndrome by laser surgery translates to improved short and long-term perinatal outcomes. Pregnancies complicated by twin reversed arterial perfusion sequence that meet surgical criteria benefit from umbilical cord occlusion. A prospective randomized trial regarding the role of laser therapy for selective intrauterine growth restriction is ongoing.
Summary: Operative fetoscopy has an important role in the management of complicated monochorionic twins.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/GCO.0b013e3282f52f72 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Adverse outcomes in monochorionic twins with amniotic fluid abnormalities without TTTS: A Case-Control study.
Eur J Obstet Gynecol Reprod Biol
January 2025
Baylor College of Medicine Houston TX, United States.
Objective: Monochorionic diamniotic (MCDA) twins with amniotic fluid abnormalities that do not meet criteria for twin-twin transfusion syndrome (TTTS) concern physicians and families. This study aimed to describe the natural history of amniotic fluid abnormalities.
Methods: In this retrospective case-control study, TTTS screening ultrasounds and clinical records throughout all MCDA twin gestations were reviewed between 2018 and 2022 at a tertiary fetal care center.
Birth weight and ponderal index percentiles for twins based on sex and chorionicity in a center of Guangdong Province, China.
Transl Pediatr
December 2024
Department of Medical Genetics Centre, Guangdong Women and Children Hospital, Guangzhou, China.
Background: Intrauterine growth restriction (IUGR) which is judged based on birth weight and gestational age, is associated with increased neonatal mobility and mortality and also has a further impact on physical and mental health during later in life. Using the birth weight percentile for singletons to assess twins might not accurately reflect the growth status of the twins; this could potentially lead to an incorrect evaluation of growth-restricted children. For a more precise assessment of twin newborns, it is beneficial to utilize twin-specific birth weight percentile curves and ponderal index (PI) curves that consider factors such as birth order and sex.
View Article and Find Full Text PDFTwin Reversed Arterial Perfusion Sequence Diagnosed Late in the Third Trimester: A Case Report and Literature Review.
Clin Case Rep
January 2025
Jimma Medical Center, Department of Gynecology and Obstetrics Jimma University Jimma Ethiopia.
The twin reversed arterial perfusion (TRAP) sequence is a rare complication associated with monochorionic twins. It is characterized by blood flow from the umbilical artery of the normal (pump) twin to the umbilical artery of the abnormal (acardiac) twin via artery-to-artery anastomosis. This condition is associated with 100% mortality in the acardiac twin and a high rate of perinatal morbidity and mortality in the pump twin, primarily due to intrauterine hypoxic injury, heart failure, and prematurity.
View Article and Find Full Text PDFRare Discordant Genetic and Structural Anomaly in Monochorionic Twins - A Challenging Approach.
J Med Ultrasound
February 2024
Department of Obstetrics and Gynaecology, Tâmega e Sousa Hospital Center, Hospital Padre Américo Avenue, Porto, Portugal.
Risk of Cord Entanglement After Iatrogenic Monoamnionicity, With Selective and Solomon Laser Treatment for Twin-To-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies.
Prenat Diagn
January 2025
Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Introduction: Fetoscopic laser surgery (FLS) is the gold standard treatment for monochorionic (MC) twin pregnancies complicated by twin-twin transfusion syndrome (TTTS). The aim of our study was to evaluate the rate and risk factors for cord entanglement in the presence of iatrogenic monoamnioticity (iMA), a consequence of inadvertent septostomy during FLS.
Methods: This is a retrospective analysis of two consecutive cohorts of FLS performed either using the selective technique from January 2004 to January 2012, or with the Solomon technique, from that date onwards.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!