Monochorionic twin pregnancies: a systematic approach to diagnosis and management

Abstract

Background: Monochorionic Twins (MC) account for approximately 20% of all twin pregnancies and are associated with increased perinatal morbidity and mortality compared to dichorionic twins. Complications unique to these pregnancies include Twin-To-Twin Transfusion Syndrome (TTTS), Twin Polycythaemia Anaemia Sequence (TAPS), Selective Intrauterine Growth Restriction (sIUGR) and death of the co-twin. Adhering to a systematic and objective approach of management, can lead to early recognition and the commencement of appropriate interventions to prevent further morbidity.
Objectives: This review highlights how complications specific to MC twins can be detected and suggests management strategies that can be instituted to improve outcomes.
Data source: The Medline, PubMed, Cochrane and TRIP databases were searched for original research and reviews on monochorionic pregnancies using the strategy; monochorionic pregnancy with/and complications OR management.
Data synthesis: Conference proceedings, case reports and personal communications were excluded though expert opinions from major bodies were considered. Only articles in English were included in this review. These were filtered for English language, human subjects and were restricted to the period 2000-2014.
Conclusion: Monochorionic twin pregnancies are associated with higher incidence of adverse perinatal outcomes compared to dichorionic pregnancies. With appropriate management and diagnostic strategies most of these complications can be recognized and prevented.