Monozygotic Twinning and Perinatal Outcomes

Chapter

Abstract

The choice made by women to delay childbearing until later in their reproductive life coupled with the more widespread use of artificial reproductive techniques has contributed to an increasing incidence of multifetal gestations. When compared to dichorionic twins, monochorionic twins are at an increased risk for congenital anomalies as well as unique conditions including twin–twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin reversed arterial perfusion (TRAP) sequence. Chorionicity can be accurately determined in the late first trimester through ultrasound examination of the interface between the intervening twin membrane and its attachment to the placenta. In the case of the monochorionic gestation, frequent ultrasound surveillance beginning at 16 weeks’ gestation is important for the timely management of perinatal complications. The current standard treatment for severe TTTS is laser photocoagulation of placental anastomoses. Selective reduction is an option in an anomalous cotwin, previable sIUGR, or TRAP sequence in monochorionic twin gestations.

Keywords

Twin–twin transfusion syndrome TTTS Monochorionic twins Twin reversed arterial perfusion sequence TRAP Acardiac twinning Selective IUGR Monoamniotic twins Multifetal pregnancies 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Division of Maternal-Fetal MedicineBaylor College of Medicine and the Texas Children’s Fetal Center, Texas Children’s HospitalHoustonUSA

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