Complications and management of monochorionic twins

Monochorionic twin pregnancies are high-risk pregnancies. Most common complications are either feto-fetal transfusion, growth discrepancy and discordant anomalies. Twin-to-Twin Transfusion Syndrome can now be treated by fetoscopic laser with high survival rates. Twin anemia polycythemia syndrome is less common and treatment is dependent on presentation. The management and outcome of growth restriction is dependent on the presence and nature of Doppler changes in the umbilical artery. Today, monochorionic status should be diagnosed at first trimester ultrasound, at what moment also prediction of adverse events can be done based on discrepancy in amniotic fluid and crown to rump length.