Skip Navigation

Monochorionic Twins Recommendations

Thumbnail of Monochorionic Twin BrochureThe following recommendations are meant for both patients and their providers as guidance during a pregnancy with monochorionic twins. For questions and referrals please call us at 1-800-RX-FETUS.

You can also download and print this information with our Monochorionic Twins Recommendations PDF brochure.

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.
Last Updated: 3/4/2010
Angela and Guy

Angela and Guy

The innovative procedures at FTC saved the lives of both Angela and Guy, whom were both diagnosed with severe CCAMs.

Watch Video

Thomas Merkord

There are moments in life you will never forget. For us that moment came when we heard the words “Well, I see 3 heads, but only 2 bodies.”

Read More

Patient Success
Make a Difference - donate to the Endowed Chair in Honor of Dr. Michael R. Harrison