Antenatal fetal surveillance in multiple pregnancies. (January 2017)

• Record Type: Journal Article
• Authors: Oepkes, Dick; Sueters, Marieke
• Is Part Of: Best practice & research. Volume 38(2017)
• Page Start: 59
• Page End: 70
• Publication Date: 2017-01
• Subjects: twin pregnancy -- multiple pregnancy -- obstetrics -- chorionicity -- antenatal surveillance; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2016.09.004
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract : Multiple pregnancies occur either spontaneously or because of assisted reproduction techniques in 1–3% of pregnancies. The presence of more than one fetus in the womb is associated with a range of possible complications, both for the mother and fetuses. Early detection of these complications followed by timely and appropriate management will reduce the risk of adverse outcomes. The techniques, skills, and experience for timely detection of complications and managing them appropriately require sufficient training and exposure. Therefore, referral of women pregnant with more than one fetus to specialized clinics is preferable. One of the most essential elements of appropriate management of multiple pregnancies is early determination of chorionicity. Monochorionic and monoamniotic multiple pregnancies require additional surveillance for a whole range of specific complications that are unique to this group. Ultrasound and Doppler are the most important tools in the management of multiple pregnancies. This chapter will summarize the current best practice, in particular the use of ultrasound and Doppler, in the antenatal management of multiple pregnancies. Highlights: A detailed first trimester scan is needed for risk selection in multiple pregnancies. Early detection and timely referral are essential in twins with TTTS, TRAP, TAPS, and sIUGR. Timely diagnosis is essential for the success of a range of fetal interventions available sIUGR in monochorionic twins presents a major challenge for the clinician. Monoamniotic twins without structural anomalies and frequently monitored have a good prognosis. Surveillance from 28 weeks onward with caesarean section between 32 and 33 weeks, after steroids, is advised.