Monochorionic diamniotic twin pregnancies

Lewi, Liesbeth

doi:10.1016/j.ajogmf.2021.100501

Cited by 18 publications

(19 citation statements)

References 64 publications

(90 reference statements)

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“…This risk is estimated to be as high as 40%. 6 Even if the co-twin survives there is a significant risk of neurological sequelae. Hypotension and hypoxia then lead to underperfusion of the co-twin causing tissue damage.…”

Section: Zygosity Chorionicity and Their Clinical Implicationsmentioning

confidence: 99%

“…Notably, either polyhydramnios nor oligohydramnios develops in either twin, distinguishing TAPS from TTTS, where significant plasma and endocrine factors exchange between fetuses occurs. 6,19,32 AA anastomoses are protective against the development of TAPS, as they mediate bidirectional blood flow and allow equilibration of the volume shifts from the chronic interfetal transfusion. 6,33 Placentas affected by TAPS have 10% to 20% AA anastomoses compared with 80% in unaffected MC placentas.…”

Section: Diagnosis Of Tapsmentioning

confidence: 99%

“…6,19,32 AA anastomoses are protective against the development of TAPS, as they mediate bidirectional blood flow and allow equilibration of the volume shifts from the chronic interfetal transfusion. 6,33 Placentas affected by TAPS have 10% to 20% AA anastomoses compared with 80% in unaffected MC placentas. 19,34,35 The AA anastomoses in TAPS placentas are smaller than the AA anastomoses in uncomplicated MC placentas, 36 contributing to the inability of the placenta to compensate for the net unidirectional blood flow.…”

Section: Diagnosis Of Tapsmentioning

confidence: 99%

“…The magnitude of the reversal observed in the growth-restricted fetus' UA Doppler is impacted by the growth discordance between the twins, the distance between the placental cord insertion sites (with decreasing distance increasing the magnitude of the reversal of flow), and the number and size of the AA anastomoses. 6 However, the placental territory discordance between the twins is unpredictable in type 3 sFGR. The large AA connections allow for constant bidirectional blood flow between the twins, which can compensate for placental territory discordance.…”

Section: Diagnosis Of Tapsmentioning

confidence: 99%

“…This rapid volume shift can lead to demise from hypovolemia or ischemic neurological injury in the larger twin and demise of the growth-restricted fetus from acute hypervolemia. 6,44 Because these events are sudden and unpredictable, the clinical course of type 3 sFGR is unpredictable. IUFD occurs despite recent normal Doppler, raising challenges in the clinical management of these pregnancies.…”

Section: Diagnosis Of Tapsmentioning

confidence: 99%

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Monochorionic Twins: TTTS, TAPS, and Selective Fetal Growth Restriction

Shanahan,

Bebbington

2023

Clinical Obstetrics &Amp; Gynecology

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With an increasing incidence of twin gestations, understanding the inherent risks associated with these pregnancies is essential in modern obstetrics. The unique differences in placentation in monochorionic twins leads to unique complications, including twin-to-twin transfusion syndrome, the twin anemia-polycythemia sequence, and selective fetal growth restriction. Not only does the understanding of the monochorionic placenta lead to an understanding of the pathophysiology of the complications of monochorionic twins, but it also has led to the development of highly effective directed fetal therapy via fetoscopic laser coagulation used in twin-to-twin transfusion syndrome.

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Section: Zygosity Chorionicity and Their Clinical Implicationsmentioning

confidence: 99%

Section: Diagnosis Of Tapsmentioning

confidence: 99%

Section: Diagnosis Of Tapsmentioning

confidence: 99%

Section: Diagnosis Of Tapsmentioning

confidence: 99%

Section: Diagnosis Of Tapsmentioning

confidence: 99%

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Monochorionic Twins: TTTS, TAPS, and Selective Fetal Growth Restriction

Shanahan,

Bebbington

2023

Clinical Obstetrics &Amp; Gynecology

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New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique

Zhang,

Jiao'e,

Chen

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesRadiofrequency ablation (RFA) is the preferred approach for selective reduction in complex monochorionic (MC) multiple pregnancies because of its ease of operation and minimal invasiveness. To optimize the RFA technique and reduce adverse pregnancy outcomes due to the heat‐sink effect of RFA therapy, we used an innovative RFA method in which a needle, an expansion‐type electrode, was expanded incrementally and stepwise. This study assessed the safety profile of this novel multistep incremental expansion (multistep) RFA method, including postoperative, maternal, and fetal complications. This study aimed to evaluate the efficacy of selective fetal reduction using multistep radiofrequency ablation (RFA) in multiple MC pregnancies.MethodsThis single‐center retrospective cohort study included all MC pregnancies treated with RFA between March 2016 and October 2022. The multistep RFA technique involved the use of an expandable needle for gradual dilation during the RFA procedure until the cord blood flow stopped. The traditional single‐step RFA method was fully extended at the start of treatment.ResultsIn this study, 132 MC multiple pregnancies were treated with selective reduction using RFA: 50 with multistep RFA and 82 with single‐step RFA. The overall survival rates were not significantly different between the two groups (81.1% vs. 72.3%, P = 0.186). Similarly, the rates of preterm premature rupture of the membranes within 2 weeks after RFA, procedure‐related complications, spontaneous preterm delivery < 34 weeks, abortion < 28 weeks, gestational age at delivery, birth weight of the live fetus, and pathological cranial ultrasound did not differ between the groups. However, there was a trend toward a prolonged procedure‐to‐delivery interval (median, 109 vs. 99 days, P = 0.377) in multistep RFA compared with single‐step RFA. Moreover, the fetal loss rate within 2 weeks after RFA in the multistep RFA group was significantly lower than that in the single‐step RFA group (10.0% vs. 24.4%, P = 0.041). The ablation time was shorter (5.30 vs. 7.75 min, P < 0.001) and the ablation energy was less (10.2 vs. 18.0 kJ, P < 0.001) in multistep RFA than in single‐step RFA. There were no significant differences in neonatal outcomes.ConclusionsOverall survival rates were similar between the two RFA methods. The multistep RFA technique resulted in significantly less ablation energy and shorter ablation time than single‐step RFA in the selective fetal reduction of MC pregnancy. The multistep RFA technique was associated with a lower risk of fetal loss within 2 weeks after RFA. Additionally, there was a trend toward a prolonged procedure‐to‐delivery interval with the multistep RFA technique.This article is protected by copyright. All rights reserved.

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Placental Conditions With Consequences for the Fetal Brain

du Plessis,

Volpe

2025

Volpe's Neurology of the Newborn

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Monochorionic diamniotic twin pregnancies

Cited by 18 publications

References 64 publications

Monochorionic Twins: TTTS, TAPS, and Selective Fetal Growth Restriction

Monochorionic Twins: TTTS, TAPS, and Selective Fetal Growth Restriction

New radiofrequency ablation procedure for selective reduction in complicated monochorionic twin or triplet pregnancy using multistep, incremental expansion technique

Placental Conditions With Consequences for the Fetal Brain

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