Optimizing outcomes in monochorionic pregnancies: screening, monitoring and management

Abstract

Monochorionic pregnancies are high-risk due to the presence of shared placental circulation. They are associated with increased rates of perinatal morbidity and mortality, even in the absence of structural or chromosomal anomalies. Complications such as twin-to-twin transfusion syndrome, selective fetal growth restriction, twin anaemia-polycythaemia sequence, and single twin demise require early recognition and expert management. Fortnightly ultrasound surveillance from 16 weeks is recommended. Screening strategies including nuchal translucency, amniotic fluid volume, Doppler velocimetry and fetal size assessment play a crucial role in risk stratification. Where selective feticide is indicated, procedures must avoid intertwin transfusion and use vascular occlusion methods such as radiofrequency ablation. Monoamnionicity, conjoined twins, and rare conditions such as TRAP sequence require additional expertise. Antenatal corticosteroids are used selectively for anticipated preterm birth. Effective management requires multidisciplinary planning, timely referral, and thoughtful counselling. This review provides an evidence-based of the screening, monitoring, and management of monochorionic pregnancies