Screening, Management and Delivery in Twin Pregnancy
Constantin von Kaisenberg1, Philipp Klaritsch2, Nicole Ochsenbein-Kölble3
1Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
Ultraschall in Der Medizin (Stuttgart, Germany : 1980)
|October 5, 2020
Summary
This guideline provides comprehensive management strategies for twin pregnancies, emphasizing chorionicity as a key prognostic factor. It details diagnosis, screening, and birth timing for dichorionic and monochorionic twins, including rare complications.
Area of Science:
- Maternal-Fetal Medicine
- Obstetrics
- Perinatology
Background:
- Twin pregnancies present unique diagnostic and management challenges.
- Chorionicity (dichorionic diamniotic, monochorionic diamniotic, monochorionic monoamniotic) is a critical prognostic factor, with monochorionic twins facing higher risks.
- Concordance and discordance for various fetal conditions necessitate tailored management approaches.
Purpose of the Study:
- To provide an evidence-based guideline for the diagnosis, screening, and management of twin pregnancies.
- To outline optimal timing and mode of birth for dichorionic and monochorionic twins.
- To address specific complications unique to monochorionic twins, such as TTTS, TAPS, and TRAP sequence.
Main Methods:
- Systematic literature search and international guideline adaptation (ISUOG, NICE).
- Development of 62 recommendations for action, supported by tables and illustrations.
- Focus on routine ultrasound monitoring from 11-13+6 weeks gestation for early detection of abnormalities.
Main Results:
- Detailed protocols for first and second-trimester screening, including chromosomal defects, anatomical abnormalities, and selective intrauterine growth restriction (sFGR).
- Management strategies for complications like TTTS, TAPS, TRAP sequence, and post-mortem of a co-twin.
- Recommendations for birth timing and mode based on chorionicity and fetal well-being.
Conclusions:
- Chorionicity determination is paramount for risk stratification in twin pregnancies.
- Early and routine monitoring with ultrasound is crucial for timely diagnosis and intervention.
- This guideline offers a comprehensive, up-to-date framework for optimizing outcomes in twin pregnancies.
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