Surveillance of monochorionic twins

Area of Science:

• Maternal-Fetal Medicine
• High-Risk Obstetrics
• Prenatal Diagnosis

Background:

• Twin pregnancies require careful monitoring, traditionally with serial ultrasounds.
• Monochorionic (MC) twins, 20% of gestations, are prone to specific complications like twin-twin transfusion syndrome (TTTS).
• Complications in MC twins, including cotwin demise risks, are absent in dichorionic twins due to placental differences.

Purpose of the Study:

• To highlight the importance of stratifying twin pregnancies into risk categories.
• To advocate for early identification of high-risk monochorionic twins.
• To emphasize the need for a new standard of care in multiple gestation management.

Main Methods:

• Review of existing literature on twin pregnancy complications and management.
• Evaluation of diagnostic capabilities of first-trimester ultrasound.
• Assessment of novel treatment technologies for MC twin complications.

Main Results:

• First-trimester ultrasound accurately distinguishes between monochorionic and dichorionic twins by examining the intertwin membrane-placental interface.
• Advanced treatments like laser photocoagulation have improved outcomes for severe TTTS.
• Stratification allows targeted management for high-risk pregnancies.

Conclusions:

• Early ultrasound differentiation of MC and dichorionic twins is essential for risk stratification.
• Identifying high-risk MC twins enables timely intervention and improved fetal outcomes.
• This diagnostic approach should be integrated as standard care for all multiple gestations.