Update on Management and Outcomes of Monochorionic Twin Pregnancies

The management of multiple pregnancies complicated by monochorionicity continues to evolve as new investigations support a change in clinical practice to optimize outcomes. Monochorionic twins are at risk of unique conditions such as monoamnionicity, conjoined twinning, twin reversed arterial perfusion sequence, twin-twin transfusion syndrome, twin anemia-polycythemia sequence, unequal placental sharing with discordant twin growth or selective fetal growth restriction, and single-twin death that puts co-twins at risk of death or neurologic injury attributable to the shared placenta. Contemporary practice guidelines recommend serial ultrasonographic surveillance of monochorionic pregnancies to increase the early detection of problems and timely management decisions that may include increased surveillance, selective reduction or pregnancy termination, referral for in utero treatment, or earlier delivery than initially planned. Improvements in prenatal diagnosis and antenatal testing and advances in fetal therapy have contributed to more favorable outcomes in these complicated monochorionic gestations.