Operative fetoscopy in complicated monochorionic twins: current status and future direction

Abstract

The aim of this article is to review the prenatal diagnosis and treatment of complicated monochorionic twins, with emphasis on surgical management via operative fetoscopy. Ultrasound is effective in the diagnosis and surveillance of several conditions that complicate monochorionic twins, such as twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, selective intrauterine growth restriction, and discordant anomalous twins. Ultrasound is also useful in identifying risk factors for poor perinatal outcomes and identifying those pregnancies that may benefit from fetal intervention. Operative fetoscopy has emerged as a useful tool in the surgical management of complicated monochorionic twins. Recent findings support the use of laser therapy for the treatment of mid-trimester twin-twin transfusion syndrome at experienced centers. The reduction in hemodynamic stress associated with definitive treatment of twin-twin transfusion syndrome by laser surgery translates to improved short and long-term perinatal outcomes. Pregnancies complicated by twin reversed arterial perfusion sequence that meet surgical criteria benefit from umbilical cord occlusion. A prospective randomized trial regarding the role of laser therapy for selective intrauterine growth restriction is ongoing. Operative fetoscopy has an important role in the management of complicated monochorionic twins.