Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T07:41:26.608Z Has data issue: false hasContentIssue false

Chapter 11 - Management of Discordant Fetal Anomaly

Published online by Cambridge University Press:  11 October 2022

By
Rajit Narayan  and
Jon Hyett
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
Get access

Summary

Twin pregnancies may be complicated in a number of ways, including through presentation with fetal abnormality. Pregnancies that are discordant for fetal anomaly may be impacted by a range of complications which are dependent on zygosity, chorionicity and the specific anomaly concerned. Discordance is defined as “occurrence of a trait or disease in only one member of a matched pair of subjects, especially twins”. In this chapter, we have reviewed the prevalence of various fetal anomalies in twin pregnancies, identified means for detecting these prenatally and reviewed a range of approaches to managing these anomalies considering the impact on the affected fetus, the co-twin and the wider family.

Keywords

twin pregnancydiscordant anomalyselective reduction
Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 112 - 122
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Boyle, B, McConkey, R, Garne, E et al. Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984–2007. BJOG 2013;120:707–16.Google Scholar
Weber, MA, Sebire, NJ. Genetics and developmental pathology of twinning. Semin Fetal Neonatal Med 2010;15:313–18.CrossRefGoogle ScholarPubMed
Silva, S, Martins, Y, Matias, A, Blickstein, I. Why are monozygotic twins different? J. Perinat Med 2011;39:195–202.CrossRefGoogle ScholarPubMed
Cuckle, H, Benn, P. Review of epidemiological factors (other than maternal age) that determine the prevalence of common autosomal trisomies. Prenat Diagn 2020; 41(5):536–44. Portico. https://doi.org/10.1002/pd.5822Google Scholar
D’Antonio, F, Familiari, A, Thilaganathan, B et al. Sensitivity of first-trimester ultrasound in the detection of congenital anomalies in twin pregnancies: population study and systematic review. Acta Obstet Gynecol Scand 2016 Dec;95(12):1359–67.Google ScholarPubMed
Phillips, T, Moore, B, Posma, E, Gillam, L, Cuzzilla, R, Cole, S. Ethical considerations in multiple pregnancy: preterm delivery in the setting of discordant fetal anomaly. Twin Res Hum Genet 2019;22:120–3.CrossRefGoogle ScholarPubMed
Vandecruys, H, Avgidou, K, Surerus, E, Flack, N, Nicolaides, KH. Dilemmas in the management of twins discordant for anencephaly diagnosed at 11+0 to 13+6 weeks of gestation. Ultrasound Obstet Gynecol 2006;28:653–8.Google Scholar
Lust, A, De Catte, L, Lewi, L, Deprest, J, Loquet, P, Devlieger, R. Monochorionic and dichorionic twin pregnancies discordant for fetal anencephaly: a systematic review of prenatal management options. Prenat Diagn 2008;28:275–9.CrossRefGoogle ScholarPubMed
Algeri, P, Russo, FM, Incerti, M et al. Expectant management in dichorionic pregnancies complicated by discordant anomalous twin. J. Perinat Med 2018;46:721–7.Google Scholar
Nassar, AH, Adra, AM, Gomez-Marin, O, O’Sullivan, MJ. Perinatal outcome of twin pregnancies with one structurally affected fetus: a case-controlled study. J Perinatol 2000;20:82–6.Google Scholar
Evans, MI, Goldberg, JD, Horenstein, J et al. Selective termination for structural, chromosomal and Mendelian anomalies: international experience. AJOG 1999;181:893–7.CrossRefGoogle ScholarPubMed
Egan, E, Reidy, K, O’Brien, L, Erwin, R, Umstad, M. The outcome of twin pregnancies discordant for trisomy 21. Twin Res Hum Genet 2014 Feb;17(1):38–44.CrossRefGoogle ScholarPubMed
Lanna, MM, Rustico, MA, Dell’Avanzo, M et al. Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center. Ultrasound Obstet Gynecol 2012;39:407–13.CrossRefGoogle Scholar
O’Donoghue, K, Barigye, O, Pasquini, L, Chappell, L, Wimalasundera, RC, Fisk, NM. Interstitial laser therapy for fetal reduction in monochorionic multiple pregnancy: loss rate and association with aplasia cutis congenita. Prenat Diagn 2008;28:535–43.Google ScholarPubMed
Paramasivam, G, Wimalasundera, R, Wiechec, M, Zhang, E, Saeed, F, Kumar, S. Radiofrequency ablation for selective reduction in complex monochorionic pregnancies. BJOG 2010;117:1294–8.CrossRefGoogle ScholarPubMed
Gaerty, K, Greer, RM, Kumar, S. Systematic review and meta-analysis of perinatal outcomes after radiofrequency ablation and bipolar cord occlusion in monochorionic pregnancies. Am J Obstet Gynecol 2015;213:637–43.CrossRefGoogle ScholarPubMed
Valsky, DV, Martinez-Serrano, MJ, Sanz, M et al. Cord occlusion followed by LASER cord transection in monochorionic monoamniotic discordant twins. Ultrasound Obstet Gynecol 2011;37:684–8.Google Scholar
Chaveeva, P, Poon, LC, Sotiriadis, A, Kosinski, P, Nicolaides, KH. Optimal method and timing of intrauterine intervention in twin reversed arterial perfusion sequence: case study and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013;166:127–32.Google Scholar
Pagani, G, D’Antonio, F, Khalil, A, Papageorghiou, A, Bhide, A, Thilaganathan, B. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2013;42:6–14.CrossRefGoogle ScholarPubMed
Lee, H, Bebbington, M, Crombleholme, TM. The North American Fetal Therapy Network registry data on outcomes of radiofrequency ablation for twin-reversed arterial perfusion sequence. Fetal Diagn Ther 2013;33:224–9.CrossRefGoogle Scholar
Morlando, M, Ferrara, L, D’Antonio, F et al. Dichorionic triplet pregnancies: risk of miscarriage and severe preterm delivery with fetal reduction versus expectant management. Outcome of a cohort study and systematic review. BJOG 2015;122:1053–60.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×