Congenital heart defects in twin gestations

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Medical Imaging

Background:

• Ultrasound technology advancements enable routine diagnosis of fetal malformations, including congenital heart defects (CHD).
• Accurate diagnosis of chorionicity in multiple gestations is crucial due to differing complication risks between dichorionic and monochorionic pregnancies.
• Assisted reproductive technology (ART) contributes to the rising incidence of multiple gestations and may increase the risk of monochorionic pregnancies.

Purpose of the Study:

• To highlight the critical role of early chorionicity diagnosis in managing multiple gestations.
• To emphasize the increased risk of CHD in monochorionic pregnancies compared to dichorionic ones.
• To advocate for targeted fetal echocardiography screening in monochorionic multiple gestations.

Main Methods:

• Review of existing literature on chorionicity, multiple gestations, and congenital heart defects.
• Analysis of diagnostic techniques for chorionicity, including limitations of the like-sex technique.
• Evaluation of the feasibility and necessity of fetal echocardiography in high-risk pregnancies.

Main Results:

• Previous studies may have overestimated monochorionic twin prevalence due to the like-sex technique.
• Monochorionic multiple gestations exhibit a significantly increased risk of CHD compared to the general population (0.5-0.8%).
• Fetal echocardiography is technically feasible and increasingly available for twin pregnancies.

Conclusions:

• Early diagnosis of chorionicity is essential for appropriate patient care and risk assessment.
• Monochorionic multiple gestations represent a high-risk group for congenital heart defects.
• Screening of monochorionic multiple gestations with fetal echocardiography is recommended.