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Monochorionic Twin Pregnancy

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Labour and Delivery
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Abstract

A monochorionic (MC) twin pregnancy occurs in 1 of 250 pregnancies and accounts for 20% of twin pregnancies and 70% of total monozygotic twins. It is responsible for a significant proportion of perinatal morbidity and mortality in twins. The main feature of MC twins is the presence of placental anastomoses which can lead to complications like Twin–Twin Transfusion Syndrome, Twin Anemia-Polycythemia Sequence, Acute Feto-Fetal Transfusion, Twin Anemia-Polycythemia Sequence, Selective Intrauterine Growth Retardation. The complexity and the uncountable number of combined complications that MC twin pregnancies can present may often blur clinical decisions. Adequate follow-up and management of MC twins can be accomplished by means of an integrated knowledge of the pathology and timely intervention.

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References

  1. Gratacós E, Ortiz JU, Martinez JM. A systematic approach to the differential diagnosis and management of the complications of monochorionic twin pregnancies. Fetal Diagn Ther. 2012;32:145–55. https://doi.org/10.1159/000342751.

    Article  PubMed  Google Scholar 

  2. Kilby MD, Bricker L on behalf of the Royal College of Obstetricians and Gynaecologists. Management of monochorionic twin pregnancy. BJOG. 2016;124:e1–e45. https://doi.org/10.1111/1471-0528.14188.

    Article  Google Scholar 

  3. Lewi L, Cannie M, Blickstein I, Jani J, Huber A, Hecher K, Dymarkowski S, Gratacós E, Lewi P, Deprest J. Placental sharing, birthweight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas. Am J Obstet Gynecol. 2007;197:587.e1–8.

    Article  PubMed  Google Scholar 

  4. Van den Bos EM, van Klink JMM, Middeldorp JM, Klumper FJ, Oepkes D, Lopriore E. Perinatal outcome after selective feticide in monochorionic twin pregnancies. Ultrasound Obstet Gynecol. 2013;41:653–8. https://doi.org/10.1002/uog.12408.

    Article  PubMed  Google Scholar 

  5. Thorson HL, Ramaeker DM, Emery SP. Optimal interval for ultrasound surveillance in monochorionic twin gestations. Obstet Gynecol. 2011;117(1):131–5. https://doi.org/10.1097/AOG.0b013e31820292ec.

    Article  PubMed  Google Scholar 

  6. De Paepe ME, De Koninck P, Friedman RM. Vascular distribution patterns in monochorionic twin placentas. Placenta. 2005;26(6):471–5. https://doi.org/10.1016/j.placenta.2004.06.014.

    Article  PubMed  Google Scholar 

  7. Chalouhi GE, Stirnemann JJ, Salomon LJ, Essaoui M, Quibel T, Ville Y. Specific complications of monochorionic twin pregnancies: twin–twin transfusion syndrome and twin reversed arterial perfusion sequence. Semin Fet Neonat Med. 2010;15(6):349–56. https://doi.org/10.1016/j.siny.2010.09.003.

    Article  CAS  Google Scholar 

  8. Shinar S, Agrawal S, El-Chaâr D, et al. Selective fetal reduction in complicated monochorionic twin pregnancies: a comparison of techniques. Prenat Diagn. 2021;41:52–60. https://doi.org/10.1002/pd.5830.

    Article  PubMed  Google Scholar 

  9. Yinon Y, Meir EB, Berezowsky A, Weisz B, Schiff E, Mazaki-Tovi S, et al. Circulating angiogenic factors in monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome and selective intrauterine growth restriction. Am J Obstet Gynecol. 2014;210:141.e1–7. https://doi.org/10.1016/j.ajog.2013.09.022.

    Article  CAS  PubMed  Google Scholar 

  10. Townsend R, D’Antonio F, Sileo FG, Kumbay H, Thilaganathan B, Khalil A. Perinatal outcome of monochorionic twin pregnancy complicated by selective fetal growth restriction according to management: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019;53:36–46. https://doi.org/10.1002/uog.20114.

    Article  CAS  PubMed  Google Scholar 

  11. Ortiz JU, Eixarch E, Peguero A, Lobmaier SM, Bennasar M, Martinez JM, Gratacós E. Chorioamniotic membrane separation after fetoscopy in monochorionic twin pregnancy: incidence and impact on perinatal outcome. Ultrasound Obstet Gynecol. 2016;47:345–9. https://doi.org/10.1002/uog.14936.

    Article  CAS  PubMed  Google Scholar 

  12. Dias T, Bhide A. Multiple pregnancy. Arias’ practical guide to high-risk pregnancy and delivery, a south Asian perspective. 4th ed. Amsterdam: Elsevier; 2015. p. 170–83.

    Google Scholar 

  13. Van Mieghem T, Eixarch E, Gucciardo L, Done E, Gonzales I, Van Schoubroeck D, Lewi L, Gratacos E, Deprest J. Outcome prediction in monochorionic diamniotic twin pregnancies with moderately discordant amniotic fluid. Ultrasound Obstet Gynecol. 2011;37:15–21. https://doi.org/10.1002/uog.8802.

    Article  PubMed  Google Scholar 

  14. Vergote S, Lewi L, Gheysen W, De Catte L, Devlieger R, Deprest J. Subsequent fertility, pregnancy, and gynecologic outcomes after fetoscopic laser therapy for twin-twin transfuse on syndrome compared with normal monochorionic twin gestations. Am J Obstet Gynecol. 2018;218:447.e1–7. https://doi.org/10.1016/j.ajog.2018.01.013.

    Article  PubMed  Google Scholar 

  15. Conte G, Righini A, Griffiths PD, Rustico M, Lanna M, Mackie FL, Pinelli L, Prefumo F, Persico N, Igra MS, Parazzini C. Brain-injured survivors of monochorionic twin pregnancies complicated by single intrauterine death: MR findings in a multicenter study. Radiology. 2018;288(2):582–90. https://doi.org/10.1148/radiol.2018171267.

    Article  PubMed  Google Scholar 

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Dangal, G., Bajracharya, N. (2023). Monochorionic Twin Pregnancy. In: Garg, R. (eds) Labour and Delivery. Springer, Singapore. https://doi.org/10.1007/978-981-19-6145-8_22

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  • DOI: https://doi.org/10.1007/978-981-19-6145-8_22

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-6144-1

  • Online ISBN: 978-981-19-6145-8

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