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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
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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

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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

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