Monochorionic diamniotic twins: What do I tell the prospective parents?

Lewi, Liesbeth

doi:10.1002/pd.5705

Cited by 25 publications

(17 citation statements)

References 61 publications

(66 reference statements)

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“…Monochorionic-diamniotic (MCDA) twin pregnancies, characterized by two amniotic sacs, but one single, shared placenta, account for approximately one in 300 pregnancies ( 1 ). The vascular connections of MCDA twins are associated with multiple complications causing increased mortality rates ( 2 ).…”

Section: Introduction/backgroundmentioning

confidence: 99%

“…These vascular complications can be significantly improved through early detection and fetal therapy ( 2 ). MCDA twin pregnancies are typically diagnosed between 11 and 13 weeks of gestation ( 1 ). It is critical that MCDA pregnancies are diagnosed as early as possible due to the potential complications that can arise as a result of the shared placenta ( 2 ).…”

Section: Introduction/backgroundmentioning

confidence: 99%

“…It is critical that MCDA pregnancies are diagnosed as early as possible due to the potential complications that can arise as a result of the shared placenta ( 2 ). Some of the most common complications observed in MCDA pregnancies include twin anemia-polycythemia sequence (TAPS) and twin–twin transfusion syndrome (TTTS) caused by the connections in the placenta; selective intrauterine growth restriction/fetal growth restriction (sIUGR/FGR) due to unequal placental sharing; umbilical cord flow issues due to placental sharing and cord insertions; and a rare complication called twin reversed arterial perfusion where one fetus is not formed properly and causes heart issues ( 1 ).…”

Section: Introduction/backgroundmentioning

confidence: 99%

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Patient-Reported Monochorionic-Diamniotic Twin Pregnancy Management and Experiences During the COVID-19 Pandemic: A Mixed-Methods Cross-Sectional Survey

Fischbein

Welsh

Ernst-Milner³

et al. 2022

Journal of Patient Experience

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Monochorionic-diamniotic (MCDA) pregnancies are high-risk necessitating ongoing screening for serious complications and quick decision-making. COVID-19 pandemic protocols introduced unique challenges to pregnancy management and patient experience. In late 2021, an online, mixed-methods, cross-sectional survey recruited 561 participants who experienced an MCDA pregnancy within five years. Analyses included descriptive and bivariate statistics and thematic analysis. Findings suggest the pandemic did not negatively affect screening/diagnosis for these participants. Care consistent with guidelines was received by most, with care slightly better during the pandemic. Almost 80% (79.0%) received an MCDA diagnosis by gestational week 14 before the pandemic, 87.8% during. Most received biweekly ultrasounds, 88.0% prior to the pandemic, 88.9% during. Experiences were affected in other ways for almost 44% of participants pregnant during COVID-19; in ways likely shared by other high-risk pregnancies. Thematic analysis revealed management during COVID-19 impacted self-advocacy and emotions (eg, alienation, anxiety), made care seem impersonal, and resulted in delayed or canceled appointments. Policies should be considered, so future healthcare disruptions do not impact patients and preserve in-person health care with access to a support person.

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Section: Introduction/backgroundmentioning

confidence: 99%

Section: Introduction/backgroundmentioning

confidence: 99%

Section: Introduction/backgroundmentioning

confidence: 99%

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Patient-Reported Monochorionic-Diamniotic Twin Pregnancy Management and Experiences During the COVID-19 Pandemic: A Mixed-Methods Cross-Sectional Survey

Fischbein

Welsh

Ernst-Milner³

et al. 2022

Journal of Patient Experience

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“…Association of amyoplasia with monozygotic twin pregnancy, with one of the twins being affected, is well established (Hall, 2021;Hall et al, 1983Hall et al, , 2014. Six to ten percent of the total reported cases of amyoplasia are reported in one of the twins from monozygotic pregnancies, this is out of proportion as the incidence of monozygotic/ monochorionic pregnancies is about 1:250 to 1:300 worldwide (Lewi, 2020). Amyoplasia is slightly more common in males (Hall et al, 2014), which is surprising for monozygotic twins, as normally, there are more females than males in monozygotic twins (Hall, 2003).…”

Section: Introductionmentioning

confidence: 99%

Amyoplasia in monochorionic monozygotic pregnancy following interstitial laser

Gupta

Sharma

2022

American J of Med Genetics Pt A

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Amyoplasia is a specific form of arthrogryposis, without any genetic cause. Six to ten percent of amyoplasia cases are one of the monozygotic twins, with the other twin being normal. Failure of maturation of anterior horn cells (AHCs) due to ischemic injury has been postulated as the primary pathological change, leading to arrest in the development of muscle fibers supplied by the affected AHCs with the typical limb positioning seen in amyoplasia. Twin‐to‐twin transfusion syndrome (TTTS) is an important risk factor for ischemic injury in monozygotic twin pregnancies. We present a case of monochorionic diamniotic twin pregnancy with features of TTTS at 12 weeks who underwent interstitial laser followed by the development of lower limb akinesia in the surviving fetus. Possible causes of amyoplasia are discussed.

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“…Due to the existence of placental vascular anastomoses and unequal placental sharing, monochorionic diamniotic twins are at increased risk of antenatal complications and perinatal mortality 1,2 . Monochorionic diamniotic twins occur in approximately 1 in 300 pregnancies 3 . Antenatal complications can include twin‐twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) 1,2,4 .…”

mentioning

confidence: 99%

Selective Fetal Growth Restriction Type III

Chmait

Monson

Korst

et al. 2021

J of Ultrasound Medicine

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Objectives Per a recent expert definition, diagnosis of selective fetal growth restriction (sFGR) in monochorionic diamniotic twins is based on an estimated fetal weight (EFW) <3% as sole criterion and/or combinations of 4 contributory criteria (1 twin EFW <10%; 1 twin abdominal circumference <10%; EFW discordance ≥25%; and smaller twin umbilical artery [UA] pulsatility index >95th percentile). We assessed these criteria in sFGR Type III (intermittent absent or reversed end‐diastolic flow of the UA [iAREDF]) patients to test whether meeting the more stringent parameters of the consensus definition had worse outcomes, that is, progression to sFGR Type II (persistent AREDF) or twin‐twin transfusion syndrome; or secondarily, decreased dual survivorship. Methods This was a retrospective study of referred sFGR Type III patients (2006–2017). Patients were retrospectively categorized using consensus criteria for 2 comparisons: 1) EFW <3% versus remaining cohort; 2) EFW <3% or met all 4 contributory criteria versus remaining cohort. Results Forty‐eight patients were studied. Comparison 1: EFW <3% patients (58.3%) were not more likely to demonstrate disease progression (46.4% versus 65.0%, P = .2489) or worse dual survivorship (78.6% versus 85.0%, P = .7161). Comparison 2: EFW <3% or met all 4 contributory criteria (75.0%) patients were not more likely than the others to demonstrate progression (44.4% versus 83.3%, P = .0235) or worse dual survivorship (80.6% versus 83.3%, P = 1.0000). Conclusions In a referred cohort of sFGR Type III patients, there was no evidence that meeting more stringent parameters of the consensus definition was associated with disease progression or dual survivorship.

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Monochorionic diamniotic twins: What do I tell the prospective parents?

Cited by 25 publications

References 61 publications

Patient-Reported Monochorionic-Diamniotic Twin Pregnancy Management and Experiences During the COVID-19 Pandemic: A Mixed-Methods Cross-Sectional Survey

Patient-Reported Monochorionic-Diamniotic Twin Pregnancy Management and Experiences During the COVID-19 Pandemic: A Mixed-Methods Cross-Sectional Survey

Amyoplasia in monochorionic monozygotic pregnancy following interstitial laser

Selective Fetal Growth Restriction Type III

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