Monochorionic Twins: A Delicate Balance

Lopriore, Enrico; Lewi, Liesbeth; Khalil, Asma

doi:10.3390/jcm8101711

Cited by 12 publications

(8 citation statements)

References 13 publications

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“…This does not mean that twins in general might make it easier or more difficult for interventions to be effective, but it suggests that there are no individual differences in intervention effects on the parents for the two children within their family. For example, first-born versus second-born twin children might have experienced divergent environments in utero and show different behavior patterns after birth (for extreme cases, see Lopriore et al [ 47 ]). Dizygotic twins, potentially phenotypically more different than monozygotic twins, may also trigger different parenting behavior and differential intervention effects of the VIPP-SD program.…”

Section: Discussionmentioning

confidence: 99%

Video-feedback promotes sensitive limit-setting in parents of twin preschoolers: a randomized controlled trial

et al. 2021

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Background Primary aim of the current randomized controlled trial was to test the effectiveness of the parenting intervention ‘Video-feedback to promote Positive Parenting and Sensitive Discipline’ (VIPP-SD) in a sample of parents of preschool-aged twins, as well as differential susceptibility to intervention efforts, that is, whether more temperamentally reactive parents would profit more from the VIPP-SD than parents with lower reactivity. Methods The sample consisted of 202 families with same-sex twins [N = 404 children, mean age 45 months (SD = 6.81)]. Randomization was done at the family level in a 2:3 ratio, with 83 families (41%) randomized to the VIPP-SD group, and 119 families (59%) to the control group. After two pre-tests in year 1 and year 2 of the study, the VIPP-SD was implemented in the third year, with a post-test assessment 1 month after the five intervention sessions. Parental sensitivity was observed during structured play in which parent and child copied a drawing together in a computerized Etch-A-Sketch paradigm. Parental limit-setting was observed in a ‘don’t touch’ task in which the parent required from the child to abstain from playing with attractive toys. Parents interacted with each of their twins in separate sessions. Results The VIPP-SD intervention had a positive impact on the level of parents’ positive limit-setting in interaction with their preschool twins, and this positive effect was most pronounced when the parents completed at least five intervention sessions. However, the intervention did not enhance parental sensitivity during structured play. Parents with higher reactivity were not more open to the impact of the intervention, thus for this temperamental marker differential susceptibility in adults was not supported. Conclusions The current study is unique in targeting families with twin preschoolers, providing proof of principle that coaching parents with video-feedback promotes parental sensitive limit-setting to both children. It remains to be seen whether this finding can be replicated in families with non-twin siblings, or other parental susceptibility markers. Trial registration Trial NL5172 (NTR5312), 2015-07-20.

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Section: Discussionmentioning

confidence: 99%

Video-feedback promotes sensitive limit-setting in parents of twin preschoolers: a randomized controlled trial

et al. 2021

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“…The ability to collaborate internationally to improve our understanding of monochorionic disorders and the efficacy of their potential treatments should be considered an emergent priority. Previous authors have also made note of this valuable opportunity, stating that international multicenter cooperation can improve knowledge and serve as a base for future trials in MC twins with rare conditions [ 42 ]. Consistency in clinical guidelines will help influence clinical practice and consistency in clinical practice related to prenatal screening will help produce more reliable data that can be used to better understand monochorionicity, ultimately improving outcomes.…”

Section: Discussionmentioning

confidence: 99%

Review of International Clinical Guidelines Related to Prenatal Screening during Monochorionic Pregnancies

Nicholas

Fischbein

Ernst-Milner

et al. 2021

JCM

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We conducted a search for international clinical guidelines related to prenatal screening during monochorionic pregnancies. We found 25 resources from 13 countries/regions and extracted information related to general screening as well as screening related to specific monochorionic complications, including twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (SFGR), and twin anemia-polycythemia sequence (TAPS). Findings reveal universal recommendation for the early establishment of chorionicity. Near-universal recommendation was found for bi-weekly ultrasounds beginning around gestational week 16; routine TTTS and SFGR surveillance comprised of regularly assessing fetal growth, amniotic fluids, and bladder visibility; and fetal anatomical scanning between gestational weeks 18–22. Conflicting recommendation was found for nuchal translucency screening; second-trimester scanning for cervical length; routine TAPS screening; and routine umbilical artery, umbilical vein, and ductus venosus assessment. We conclude that across international agencies and organizations, clinical guidelines related to monochorionic prenatal screening vary considerably. This discord raises concerns related to equitable access to evidence-based monochorionic prenatal care; the ability to create reliable international datasets to help improve the quality of monochorionic research; and the promotion of patient safety and best monochorionic outcomes. Patients globally may benefit from the coming together of international bodies to develop inclusive universal monochorionic prenatal screening standards.

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“…Monochorionic (MC) twins are identical twins who share one placenta, with vascular anastomoses connecting the circulations of both fetuses. Although the occurrence of MC twin pregnancies is rare (only 0.4% of the general population), associated complications due to a shared placental circulation are frequent and may be very severe (Lopriore et al, 2019).…”

Section: Monochorionic Twinsmentioning

confidence: 99%

Predictive values of first trimester ultrasound screening for twin-to-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic twin pregnancies

Ali

Mohamed

Khodary

et al. 2022

ijhs

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Background: Monochorionic diamniotic (MCDA) twins are at significantly increased risk of perinatal morbidity and mortality due to shared placentation and the presence of inter-twin placental vascular anastomoses. Aim of the work: The main aim of this study was to validate first trimester ultrasound screening for twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) in monochorionic twin pregnancies using the triad of nuchal translucency (NT), cord insertion site and inter-twin discordance in fetal size. Summary: We have demonstrated that NT and CRL were significantly higher in TTTS group than sIUGR group. And difference in NT, CRL and cord insertion site was identified as predictive markers for sIUGR and TTTS.

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Monochorionic Twins: A Delicate Balance

Abstract: Monochorionic (MC) twins are identical twins who share one placenta, with vascular anastomoses connecting the circulations of both fetuses [...]

Cited by 12 publications

References 13 publications

Video-feedback promotes sensitive limit-setting in parents of twin preschoolers: a randomized controlled trial

Video-feedback promotes sensitive limit-setting in parents of twin preschoolers: a randomized controlled trial

Review of International Clinical Guidelines Related to Prenatal Screening during Monochorionic Pregnancies

Predictive values of first trimester ultrasound screening for twin-to-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic twin pregnancies

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