Monochorionic Twins Recommendations

Complications Unique to Monochorionic Twins

• Amniotic fluid discordance
• Growth discordance ( > 20%)
• Unequal placental sharing
• Selective intrauterine growth restriction (S-IUGR) in one fetus
• TTTS - clinically defined as a deepest vertical pocket of > 8 cm in one twin and < 2 cm in in the other twin, simultaneously. Note: growth discordance may also be seen but not necessary for the diagnosis.
• Anomalies in on fetus
• TRAP Sequence

Components of UCSF Evaluation

• Level II anatomic survey for fetal anomalies
• Special attention paid to cord insertions and vascular mapping
• Fetal echocardiagraphy both for the structural integrity and functional (systolic and diastolic) pathology
• Fetal brain MRI > 22 weeks when indicated and appropriate

Potential Surgical Procedures

• Selective fetoscopic laser ablation
• Radiofrequency ablation (RFA) cord occlusion

Timeframe for Referrals to UCSF

Consider Referral

• Significant amniotic fluid discordance
  While TTTS is defined as having a DVP > 8 cm and < 2 cm simultaneously, we encourage referral for evaluation if the fluid pockets become significantly discordant even before TTTS criteria are met
• Significant growth discordance defined as > 20% difference
• Polyhydramnios in one twin with normal fluid in the other
• Suspicion of discordant anomaly

We encourage you to call our center to discuss your findings if you have concerns at 1-800-RX-FETUS

Call for Timely Referral (need to see patient within 1 week)

• DVP > 8 cm and < 2 cm with bladder visualized in donor and normal umbilical artery dopplers

Call for Urgent Referral (need to see patient within a couple days)

• DVP > 8 cm and < 2 cm with no visible bladder in donor and/or abnormal umbilical doppler
• Suspected Hydrops

What is Needed For Referral

Patients referred to UCSF for an evaluation should have the following faxed to 415-502-0660:

• Demographic information
• A copy of the front/back of their health insurance card
• All OB/Perinatal medical records
• If insurance authorization is required, please download the Monochorionic Evaluation Codes PDF for the proper codes.