Recent Updates in the Management of Monochorionic Twin Pregnancy

Abstract

Monochorionic pregnancies are at high risk of developing severe complications leading to high perinatal morbidity and mortality. About 15% of these twins have unidirectional anastomosis of the placenta, which is responsible for the major complications specific to monochorionic pregnancies. An important first step in the management is the identification of the chorionicity. Once it is identified, a close follow-up every 2 weeks is vital to allow early detection of complications and their management. Approximately 1 in 10 monochorionic pregnancies develops twin-to-twin transfusion syndrome, congenital anomalies, anaemia polycythaemia sequence, selective intrauterine growth restriction and intrauterine death of a co-twin. Rare complications that can occur are twin reversed arterial perfusion syndrome. Timely screening and detection of all such complications can lead to appropriate intervention such as in utero foetoscopic laser treatment. These interventions can increase the survival rate of at least one or both twins with reduced neonatal morbidity. Besides, early detection can facilitate parents to have an informed choice to decide if the prognosis of the pregnancy is otherwise not good.