Management of other complications specific to monochorionic twin pregnancies

Pasquini, L., Wimalasundera, R. C. and Fisk, N. M. (2004) Management of other complications specific to monochorionic twin pregnancies. Best Practice and Research: Clinical Obstetrics and Gynaecology, 18 4: 577-599. doi:10.1016/j.bpobgyn.2004.04.011

Author Pasquini, L.
Wimalasundera, R. C.
Fisk, N. M.
Title Management of other complications specific to monochorionic twin pregnancies
Journal name Best Practice and Research: Clinical Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1521-6934
Publication date 2004-08
Sub-type Article (original research)
DOI 10.1016/j.bpobgyn.2004.04.011
Volume 18
Issue 4
Start page 577
End page 599
Total pages 23
Place of publication Oxford, United Kingdom
Publisher Bailliere Tindall
Language eng
Abstract Monochorionic (MC) twins have a 3-10-fold higher perinatal mortality and morbidity than dichorionic twins. This is largely attributable to their common vascular architecture and the high rate of discordant fetal growth, growth restriction and congenital abnormalities. In the event of a single intrauterine death (IUD), intertwin agonal transfusion results in up to a 38% risk of death and a 46% risk of neurological injury to the co-twin. This chapter addresses the management of complications unique to MC twins. The primary aim of management is to prevent single IUD or, if inevitable, prevent agonal transfusion occurring by vascular occlusive selective feticide. Older fetoscopic techniques have been replaced by the simpler ultrasound-guided techniques of interstitial laser and bipolar cord occlusion. Their application in twin reversed-arterial perfusion sequence has been associated with a 50% reduction of perinatal mortality in the pump twin. Moreover, prophylactic interstitial laser therapy in early pregnancy might obviate the technical and clinical difficulties in the presence of fetal decompensation in later pregnancy. Recent strategies to reduce the high perinatal mortality due to cord entanglement in antenatally diagnosed monoamniotic twins including medical amnioreduction and elective caesarean delivery at 32 weeks, are also discussed.
Keyword Conjoined
Cord entanglement
Cord occlusion
Monoamniotic twins
Multiple pregnancy
Selective feticide
Twin reversed-arterial perfusion sequence
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Faculty of Health and Behavioural Sciences -- Publications
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Citation counts: TR Web of Science Citation Count  Cited 21 times in Thomson Reuters Web of Science Article | Citations
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