This information is critical for detecting and staging TTTS and for evaluating fetuses diagnosed with sFGR. Doppler studies may show absence or reversal of EDF in the UA of the donor, information that is used in staging TTTS [70]. US Echocardiography Fetal Echocardiography can be performed for surveillance of DC or multichorionic gestations when cardiac defects or secondary cardiac decompensation is expected or observed. Multiple Gestations for fetal intervention. Fetoscopic laser ablation of placental vascular anastomoses can help reverse cardiac dysfunction, even in the most severe cases of TTTS [80]. Finneran et al [80] showed that laser treatment for TTTS causes rapid improvement in the cardiac function of recipient fetuses and that preoperative recipient myocardial performance index does not correlate with survival of either twin postoperatively. Hence, monitoring of cardiac function should be continued even after fetal intervention has been performed [80-82]. US Pregnant Uterus Biophysical Profile BPP can be performed in late second and third trimesters for assessing fetal well-being for all multiple pregnancies. US Pregnant Uterus Transabdominal Transabdominal US of the pregnant uterus continues to be the mainstay for surveillance imaging of complicated multiple gestations. Complicated multiple gestations require sonographic surveillance at frequent intervals varying between 2 to 3 days to 2 to 3 weeks based on the abnormality and fetal status [9]. Higher-risk gestations merit frequent surveillance. Due to variability and SDs in measurements, growth and biometry is usually performed no more frequently than every 2 weeks [9]. The discordance in estimated fetal weights should be calculated and documented at each scan in which growth and fetal weight estimates are performed. If prior history of cesarean delivery or uterine instrumentation is present, assessment for placenta accreta spectrum can be performed.
Multiple Gestations. This information is critical for detecting and staging TTTS and for evaluating fetuses diagnosed with sFGR. Doppler studies may show absence or reversal of EDF in the UA of the donor, information that is used in staging TTTS [70]. US Echocardiography Fetal Echocardiography can be performed for surveillance of DC or multichorionic gestations when cardiac defects or secondary cardiac decompensation is expected or observed. Multiple Gestations for fetal intervention. Fetoscopic laser ablation of placental vascular anastomoses can help reverse cardiac dysfunction, even in the most severe cases of TTTS [80]. Finneran et al [80] showed that laser treatment for TTTS causes rapid improvement in the cardiac function of recipient fetuses and that preoperative recipient myocardial performance index does not correlate with survival of either twin postoperatively. Hence, monitoring of cardiac function should be continued even after fetal intervention has been performed [80-82]. US Pregnant Uterus Biophysical Profile BPP can be performed in late second and third trimesters for assessing fetal well-being for all multiple pregnancies. US Pregnant Uterus Transabdominal Transabdominal US of the pregnant uterus continues to be the mainstay for surveillance imaging of complicated multiple gestations. Complicated multiple gestations require sonographic surveillance at frequent intervals varying between 2 to 3 days to 2 to 3 weeks based on the abnormality and fetal status [9]. Higher-risk gestations merit frequent surveillance. Due to variability and SDs in measurements, growth and biometry is usually performed no more frequently than every 2 weeks [9]. The discordance in estimated fetal weights should be calculated and documented at each scan in which growth and fetal weight estimates are performed. If prior history of cesarean delivery or uterine instrumentation is present, assessment for placenta accreta spectrum can be performed.