title: Troubles with twins: fetoscopic therapy.
abstract: Monochorionic twin gestations present challenges in perinatal management not seen in dichorionic twins or singleton pregnancies. Monochorionic twin gestations may be complicated by (1) a monoamniotic presentation, (2) a structurally anomalous cotwin, (3) twin reversed arterial perfusion sequence, (4) and the twin-twin transfusion syndrome. Each of these conditions is associated with increased morbidity and mortality rates. Although a variety of therapeutic interventions are available, fetoscopic surgery is a promising new approach to these conditions. Advances in microinstrumentation have allowed for the wider application of fetoscopy for a variety of prenatally diagnosed conditions, including "troubles with twins." This article examines the natural history, pathophysiology, diagnosis, and indications for fetoscopic surgery in complicated monochorionic twin gestations.
authors.affiliation: Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA 19104, USA.
authors.forename: R
authors.initials: R
authors.lastname: Milner
authors.forename: T M
authors.initials: TM
authors.lastname: Crombleholme
mesh_terms: D002823:Chorion; D004200:Diseases in Twins; D005260:Female; D005315:Fetal Diseases / Q000601:surgery; D005330:Fetofetal Transfusion / Q000601:surgery; D005332:Fetoscopy; D006801:Humans; D053685:Laser Therapy; D011247:Pregnancy; D014427:Twins