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Monochorionic diamniotic twins: complications and management options
Liesbeth Lewi1, Dominique Van Schoubroeck, Eduard Gratacós
1Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
Current Opinion in Obstetrics & Gynecology
|March 14, 2003
Summary
Monochorionic twins face higher risks due to placental sharing. Advances in understanding and managing complications like twin-to-twin transfusion syndrome aim to improve outcomes for these high-risk pregnancies.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Twin Gestation Research
Background:
- Monochorionic twins experience higher rates of fetal loss, mortality, and morbidity compared to dichorionic twins.
- This increased risk is attributed to shared placental vascular anastomoses and asymmetrical placental distribution.
Purpose of the Study:
- To review current understanding of complications in monochorionic twins.
- To update on pathophysiology, diagnosis, and management strategies for twin-to-twin transfusion syndrome and discordant growth.
Main Methods:
- Review of recent findings on pathophysiology and management of monochorionic twin complications.
- Discussion of fetoscopic laser coagulation, amnioreduction, and septostomy, awaiting trial results.
- Analysis of discordant growth, anomalies, and selective feticide techniques.
Main Results:
- Pathophysiology of twin-to-twin transfusion syndrome involves angioarchitecture, hemodynamics, and hormones.
- Umbilical artery Doppler may have limited predictive value in monochorionic twins.
- Laser and bipolar coagulation techniques are discussed for managing complications and selective feticide.
Conclusions:
- Recent years have seen increased insight into monochorionic twin pregnancy complications.
- Improved surveillance and management strategies are anticipated to enhance outcomes for these high-risk pregnancies.