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Updated: Jun 1, 2025

Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye
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Adverse outcomes in monochorionic twins with amniotic fluid abnormalities without TTTS: A Case-Control study.

Cara Buskmiller1, Luis Delgadillo Chabolla1, Linda Alpuing Radilla1

  • 1Baylor College of Medicine Houston TX, United States.

European Journal of Obstetrics, Gynecology, and Reproductive Biology
|January 18, 2025
PubMed
Summary

Amniotic fluid abnormalities in monochorionic diamniotic (MCDA) twins, even without meeting twin-twin transfusion syndrome (TTTS) criteria, signal increased risks. These pregnancies face higher rates of complications, interventions, and fetal demise.

Keywords:
DiamnioticFetal growth restrictionFluid discordanceFluid discrepancyIntrauterine growth restrictionLaserMonochorionicOligohydramniosPolyhydramniosTwin pregnancyTwin to twin transfusion syndrome

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Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • High-Risk Obstetrics

Background:

  • Monochorionic diamniotic (MCDA) twins present unique challenges, particularly when amniotic fluid abnormalities arise without meeting diagnostic criteria for twin-twin transfusion syndrome (TTTS).
  • These ambiguous fluid findings cause concern for clinicians and families regarding potential adverse outcomes.
  • Understanding the natural history of these borderline abnormalities is crucial for appropriate management.

Purpose of the Study:

  • To describe the natural history and clinical significance of amniotic fluid abnormalities in MCDA twins that do not meet established criteria for TTTS.
  • To identify associated complications and outcomes in these pregnancies.

Main Methods:

  • A retrospective case-control study reviewed ultrasounds and clinical records of MCDA twin gestations from 2018-2022.
  • Cases with unexplained fluid abnormalities were categorized, excluding those with clear TTTS, selective fetal growth restriction (sFGR), twin-anemia polycythemia sequence (TAPS), structural anomalies, or insufficient scan data.
  • A control group with normal fluid imaging throughout gestation was used for comparison.

Main Results:

  • Among 140 cases with non-diagnostic fluid abnormalities, compared to 224 controls, increased rates of TTTS (41%), TAPS (8%), new sFGR (11%), and laser intervention (36%) were observed.
  • Fetal demise occurred more frequently in cases (11% vs 1%).
  • Maternal admissions for surveillance and earlier delivery (33.1 vs 35.1 weeks) were also significantly higher in the case group.

Conclusions:

  • Amniotic fluid abnormalities in MCDA twins, even if not meeting TTTS criteria, serve as a critical warning sign.
  • These findings are associated with a significantly higher risk of adverse pregnancy outcomes, including fetal demise and the need for interventions.
  • Close monitoring and timely intervention are warranted for MCDA twins presenting with ambiguous fluid abnormalities.