Operative fetoscopy in complicated monochorionic twins: current status and future direction

Area of Science:

• Maternal-Fetal Medicine
• Fetal Surgery
• Reproductive Medicine

Background:

• Monochorionic twins face significant risks due to shared placental circulation.
• Complications include twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, and selective intrauterine growth restriction.
• Effective prenatal diagnosis and timely intervention are crucial for improving perinatal outcomes.

Purpose of the Study:

• To review current strategies for prenatal diagnosis of complicated monochorionic twins.
• To emphasize the role of operative fetoscopy in surgical management.
• To discuss recent advancements in fetal interventions for specific complications.

Main Methods:

• Review of current literature on prenatal diagnosis and management of complicated monochorionic twins.
• Emphasis on ultrasound for diagnosis and surveillance.
• Focus on surgical interventions including operative fetoscopy, laser therapy, and umbilical cord occlusion.

Main Results:

• Ultrasound is effective for diagnosing and monitoring various twin complications.
• Operative fetoscopy is a valuable tool for surgical management.
• Laser therapy for twin-twin transfusion syndrome improves perinatal outcomes.
• Umbilical cord occlusion benefits selected cases of twin reversed arterial perfusion sequence.

Conclusions:

• Operative fetoscopy plays a vital role in managing complicated monochorionic twins.
• Fetal interventions, particularly laser therapy and cord occlusion, offer improved outcomes.
• Ongoing research, like trials for selective intrauterine growth restriction, will further refine management strategies.