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Chapter 29 - New Frontiers in Multiple Pregnancy Management

Published online by Cambridge University Press:  11 October 2022

By
Caroline J. Shaw  and
Christoph C. Lees
Edited by
Leanne Bricker ,
Julian N. Robinson  and
Baskaran Thilaganathan
Leanne Bricker
Affiliation:
Corniche Hospital, Abu Dhabi
Julian N. Robinson
Affiliation:
Brigham & Women's Hospital, Boston
Baskaran Thilaganathan
Affiliation:
St George's Hospital Medical School, University of London
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Summary

Multiple pregnancies, especially those involving monochorionic placentation, have increased risks compared to singleton pregnancies. Better understanding of the angioarchitecture and vascular function of monochorionic placentae will help describe the pathophysiology of disease in monochorionic pregnancies. Research in this area will guide risk stratification, non-invasive diagnosis and treatment strategies in MCDA twins, notably in relation to twin-twin transfusion syndrome (TTTS) and selective growth restriction. Here, we describe MRI and ultrasound advances in placental vascular imaging, including blood oxygenation level dependant (BOLD-MRI), low flow Doppler, and the development of high intensity focused ultrasound (HIFU) as a non-invasive treatment for TTTS and twin reversed arterial perfusion (TRAP) sequence in monochorionic twins.

Keywords

Monochorionic twinsmonochorionic placental anastomoseshigh intensity focused ultrasound (HIFU)BOLD-MRIlow flow DopplerTTTSselective growth restriction
Type
Chapter
Information
Management of Multiple Pregnancies
A Practical Guide
 , pp. 318 - 328
Publisher: Cambridge University Press
Print publication year: 2022

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