Abstract
We conducted a search for international clinical guidelines related to prenatal screening during monochorionic pregnancies. We found 25 resources from 13 countries/regions and extracted information related to general screening as well as screening related to specific monochorionic complications, including twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (SFGR), and twin anemia-polycythemia sequence (TAPS). Findings reveal universal recommendation for the early establishment of chorionicity. Near-universal recommendation was found for bi-weekly ultrasounds beginning around gestational week 16; routine TTTS and SFGR surveillance comprised of regularly assessing fetal growth, amniotic fluids, and bladder visibility; and fetal anatomical scanning between gestational weeks 18–22. Conflicting recommendation was found for nuchal translucency screening; second-trimester scanning for cervical length; routine TAPS screening; and routine umbilical artery, umbilical vein, and ductus venosus assessment. We conclude that across international agencies and organizations, clinical guidelines related to monochorionic prenatal screening vary considerably. This discord raises concerns related to equitable access to evidence-based monochorionic prenatal care; the ability to create reliable international datasets to help improve the quality of monochorionic research; and the promotion of patient safety and best monochorionic outcomes. Patients globally may benefit from the coming together of international bodies to develop inclusive universal monochorionic prenatal screening standards.
Highlights
Clinical guidelines serve to optimize the care of patients by assisting clinicians and other healthcare professionals [1]
A recent review examined eight international guidelines related to management of twin pregnancies and found consensus among the guidelines in the areas of (1) first trimester screening including assessment of gestational age as well as identification of chorionicity and amnionicity, (2) nuchal translucency and anatomy screenings, and (3) biweekly ultrasounds for monochorionic and every 4th week for dichorionic pregnancies [4]
Near-universal recommendation was found for bi-weekly ultrasounds beginning around gestational week 16; routine twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (SFGR) surveillance comprised of regularly assessing fetal growth, amniotic fluids, and bladder visibility; and fetal anatomical scanning between gestational weeks 18–22
Summary
Clinical guidelines serve to optimize the care of patients by assisting clinicians and other healthcare professionals [1]. A recent review examined eight international guidelines related to management of twin pregnancies and found consensus among the guidelines in the areas of (1) first trimester screening including assessment of gestational age as well as identification of chorionicity and amnionicity, (2) nuchal translucency and anatomy screenings, and (3) biweekly ultrasounds for monochorionic and every 4th week for dichorionic pregnancies [4]. Given the high risk nature of monochorionic twin pregnancies and the possibility of complications [5], further attention is required to understand how national and international guidelines compare with regard to prenatal screening for monochorionic twin pregnancies. Within the topic of monochorionic pregnancy, there exist several internationally dispersed clinical guidelines related to prenatal screening
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