Antenatal fetal assessment: multifetal gestation--an overview

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatology

Background:

• The increasing prevalence of multifetal gestations necessitates robust antenatal surveillance strategies.
• Twin pregnancies present unique risks compared to singleton pregnancies, often related to fetal growth and placental development.
• Current data for higher-order multiple gestations are limited, focusing this review on twin pregnancies.

Purpose of the Study:

• To examine the application of various antenatal surveillance modalities in twin pregnancies.
• To review the evidence supporting the use of these methods for twin gestation assessment.
• To present a strategic outline for the assessment of twin pregnancies based on current data.

Main Methods:

• Sonographic assessments including fetal biometry, serial growth studies, amniotic fluid volume, and Doppler velocimetry.
• Biophysical profile testing and nonstress testing (fetal heart rate monitoring).
• Review of existing evidence for the application of these modalities in twin pregnancies.

Main Results:

• Sonographic tools and fetal heart rate testing are vital components of antepartum surveillance in twin gestations.
• Specific attention is given to unique risks such as twin-twin transfusion syndrome, monoamniotic twinning, and intrauterine fetal demise.
• The article synthesizes current data to propose a structured approach to twin pregnancy assessment.

Conclusions:

• Effective antenatal surveillance using established modalities is essential for managing the complexities of twin pregnancies.
• A strategic outline is provided to guide the assessment and management of twin gestations.
• Further research may be needed to refine surveillance protocols, particularly for higher-order multiples.