This surveillance method incorporates a comprehensive list of maternal and fetal surveillance parameters to determine how often patients need to be seen and when intervention of delivery is advisable. Baschat has long-standing experience applying his integrated surveillance approach. Fetal surveillance is complex, because multiple aspects of the condition in each fetus can change.Following cord coagulation, the normal co-twin has an over 90 percent chance for an uncomplicated pregnancy course. This is a management option for pregnancies complicated by severe SIUGR, where it is deemed unlikely that the growth-restricted baby will survive, or where discordant fetal anomalies or TRAP sequence are present. Cord occlusion offers the best chance for one baby. Baschat has been able to achieve survival rates over 95 percent coupled with minimal recurrence risk for pregnancies complicated by TTTS. Developing the equatorial dichorionization, Dr. Fetoscopic laser occlusion of placental anastomoses offers the best outcome for pregnancies complicated by TTTS or TAPS.The management expertise that is required for complicated monochorionic twins depends on the specific conditions. Management Options for Complicated Monochorionic Twin Pregnancy Because the conditions can evolve, ongoing surveillance is required to detect deviations of the clinical course that may require specific therapy. This is done by advanced ultrasound techniques using high-resolution scanning, Doppler techniques and three-dimensional imaging. In addition, a detailed and sometimes repetitive assessment of the anatomy of both fetuses is required. Once it has been determined that the placenta is monochorionic, detection of complications requires close attention to signs of growth discordance, volume discordance or discordant blood counts between fetuses. The finding that identifies a monochorionic placenta with a high level of certainty is the so-called lambda sign, an ultrasound finding in those with monochorionic placentas. This is best done in the first 12 weeks of pregnancy- the first trimester-by a prenatal ultrasound. The first and most critical step in identifying risks for complications in multiple pregnancies is to determine whether the placenta is monochorionic. But one-third of monochorionic twin pregnancies are at risk for complications when sharing between both babies is not equal. In uncomplicated monochorionic twin gestations, the blood exchange between both babies is equal, and the placental mass is equally shared. The position of the vascular equator determines the placental share of each baby. The area of the placenta where the blood vessels of both babies meet is called the vascular equator, because it is the natural dividing lines between the portions of the placenta that belong predominantly to one baby or the other. Sometimes, shunting between these anastomoses can switch back and forth from one heartbeat to the next.Įach baby has a share of the placenta that is available for its nutrient delivery. The direction of blood flow in AA and VV anastomoses depends on which baby happens to have the higher pressure in these vessels and therefore can fluctuate between sides, a process called bidirectional shunting. These blood vessel connections can be between an artery of one baby and the vein of the other baby (AV anastomosis), between an artery from each baby (AA anastomosis) and between two veins from each baby (VV anastomosis).īecause blood pressure is higher in arteries, AV anastomoses allow blood or volume exchange from one baby to the other, a process called unidirectional shunting. The umbilical cord of each fetus inserts into the surface of the placenta, and blood vessels that run on the surface of the placenta between these cord insertions. Common Characteristics of Monochorionic PlacentasĪll monochorionic placentas share some common characteristics.
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