Twin Pregnancy and Antenatal Examination: An Overview
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HIGH-RISK GESTATION AND PRENATAL MEDICINE (T-F CHAN, SECTION EDITOR)
Twin Pregnancy and Antenatal Examination: An Overview Stamatios Petousis & Chrysoula Margioula-Siarkou & Ioannis Kalogiannidis & Nikolaos Prapas
Published online: 24 August 2013 # Springer Science+Business Media New York 2013
Abstract Total twinning rate has increased dramatically during the past 20 years, especially in Europe and the United States. This increase is mainly attributed to the widespread implementation of assisted reproductive techniques (ART). Twin gestation presents hazards at all ranges of gestational period, including risk for fetal wastage, fetal growth restriction, preterm labor, congenital abnormalities, twin-to-twin transfusion syndrome (TTTS) regarding monochorionic twins, and increased mortality rates. This review presents a summary of the appropriate antenatal examination strategy in twin pregnancies and, in parallel, emphasizes the main clinical problems that still pose controversies. Detection of chorionicity, measurement of nuchal translucency, fetal growth assessment based on twin-adjusted customized charts, structural anomaly scan, invasive procedures, non-stress test, biophysic profile, and MRI performance are the main issues analyzed. Finally, because twin gestations represent a challenging reality of modern obstetrics, this review also elucidates on the domains characterized by lack of evidence-based consensus, therefore raising the need for further research.
Keywords Twin pregnancy . High-risk gestation . Assisted reproductive techniques . Twin-to-twin transfusion . Prenatal medicine . Monochorionic twins . Antenatal examination
S. Petousis : C. Margioula-Siarkou : I. Kalogiannidis : N. Prapas 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece S. Petousis (*) Falireos 16, Evosmos, 56224 Thessaloniki, Greece e-mail: [email protected]
Introduction Rate of twin gestation currently varies between 1-2 % of all pregnancies [1]. However, total twinning rate has increased dramatically during the past 20 years, especially in Europe and the United States [2–4]. This significant increase has been mainly attributed to the widespread implementation of assisted reproductive techniques (ART). It is estimated that 75 % of the total increase of twin pregnancies’ rate has been caused by ART methods; therefore, making a high-priority issue the reexamination of ART methods’ policies regarding the optimal number of transferred embryos [5]. Twin gestation presents hazards at all ranges of gestational period [6]. Increased risk for fetal wastage, fetal growth restriction, preterm labor, congenital abnormalities, and mortality are only a part, yet important, of the range of complications associated with twin pregnancies [7–10]. Furthermore, in case of monochorionic twins, perinatal mortality is three to five times higher than in dichorionic ones [11]. Besides, twin-totwin transfusion syndrome (TTTS) will potentially develop in 10-15 % of monochorionic gestations [12, 13]. All the af
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