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Monochorionic diamniotic twin pregnancies.

Liesbeth Lewi1

  • 1Department of Obstetrics and Gynecology, Universitaire Ziekenhuizen, Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.

American Journal of Obstetrics & Gynecology MFM
|October 14, 2021
PubMed
Summary
This summary is machine-generated.

Monochorionic diamniotic twins face risks like transfusion imbalances and growth differences. Fetoscopic laser coagulation can treat some issues, but careful management is key for optimal outcomes.

Keywords:
anomalygrowthmonochorionic diamniotic twintransfusion syndrome

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Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Twin Pregnancy Research

Background:

  • Monochorionic diamniotic (MCDA) twin pregnancies occur in about 20% of twin gestations.
  • Vascular anastomoses in MCDA twins can lead to transfusion imbalances, affecting fetal development.
  • These complications include twin-twin transfusion syndrome, twin anemia polycythemia sequence, and intertwin growth differences.

Purpose of the Study:

  • To provide an update on the pathophysiology, diagnosis, and management of common complications in MCDA twin pregnancies.
  • To highlight the role of fetoscopic laser coagulation in addressing vascular anastomoses.
  • To discuss risks associated with structural anomalies, chromosomal abnormalities, selective reduction, and spontaneous demise of one twin.

Main Methods:

  • Review of current literature on MCDA twin pregnancy complications.
  • Analysis of diagnostic methods including ultrasound for amniotic fluid and growth differences.
  • Evaluation of management strategies such as fetoscopic laser coagulation and selective reduction.

Main Results:

  • Transfusion imbalances (TTTS, TAPS) and growth discrepancies are significant concerns in MCDA twins.
  • Fetoscopic laser coagulation effectively addresses vascular anastomoses causing transfusion imbalances.
  • Structural anomalies are more common, while chromosomal anomalies appear less frequent in MCDA twins compared to singletons.

Conclusions:

  • MCDA twin pregnancies require specialized monitoring and management due to unique risks.
  • Early diagnosis and timely intervention, including fetoscopic laser coagulation, are crucial for improving outcomes.
  • Understanding the pathophysiology of complications like twin demise is vital for managing surviving twins.