The North American Fetal Therapy Network Consensus Statement: prenatal management of uncomplicated monochorionic gestations.
Owing to vascular connections within a single placenta, monochorionic gestations present distinctive prenatal management challenges. Complications that can arise as a result of unbalanced hemodynamic exchange (twin-twin transfusion syndrome and twin anemia polycythemia sequence) and unequal placental sharing (selective fetal growth restriction) should be kept in mind while prenatal management is being planned. Because of unique monochorionic angioarchitecture, what happens to one twin can directly affect the other. Death of one twin can result in death or permanent disability of the co-twin. Early detection of these unique disease processes through frequent ultrasonographic surveillance may allow the opportunity for earlier referral, intervention, or both and potentially better outcomes. Therefore, monochorionic gestations should be managed differently than dichorionic gestations or singletons. The purpose of this document is to present in detail methods for monitoring and management of uncomplicated monochorionic gestations and to review the evidence for the roles of these methods for detection of complications in clinical practice. Finally, we present evidence-based and expert opinion-supported recommendations developed by the North American Fetal Therapy Network for the diagnosis, surveillance, and delivery of uncomplicated monochorionic gestations.
Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, Yale School of Medicine, New Haven, Connecticut, and the University of Texas Health Science Center at Houston, Houston, Texas; the Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, and Columbia University Medical Center, New York, New York; the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts; Evergreen Hospital, Kirkland, Washington; the Department of Pediatrics, Division of Cardiology, and the Fetal Treatment Center, University of California San Francisco, San Francisco, California; the Departments of Obstetrics and Gynecology, Divisions of Maternal-Fetal Medicine, Weill Cornell Medical College and New York Hospital Queens, New York, New York, and the Warren Alpert Medical School of Brown University, Providence, Rhode Island; and the Division of Maternal and Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
Stephen P
SP
Emery
Mert Ozan
MO
Bahtiyar
Jodi S
JS
Dashe
Louise E
LE
Wilkins-Haug
Anthony
A
Johnson
Bettina W
BW
Paek
Anita J
AJ
Moon-Grady
Daniel W
DW
Skupski
Barbara M
BM
O'Brien
Christopher R
CR
Harman
Lynn L
LL
Simpson
D002823:Chorion; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging; D046128:Fetal Therapies; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000196:embryology; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin / Q000502:physiology; D011295:Prenatal Care / Q000592:standards*; D038522:Twinning, Monozygotic; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal