Management of Twin Pregnancies and Related Conditions

Twin pregnancies account for approximately 1–4% of births worldwide and are intrinsically associated with higher maternal and perinatal morbidity than singletons. Management is predicated on accurate determination of chorionicity and amnionicity, which guide surveillance strategies and timing of delivery. Monochorionic diamniotic twins require intensive monitoring for selective foetal growth restriction and twin-to-twin transfusion syndrome, employing serial ultrasound and Doppler velocimetry. Dichorionic diamniotic twins, while less prone to intertwin vascular complications, remain at elevated risk of preterm delivery, hypertensive disorders and gestational diabetes. Key interventions include cervical assessment, optimisation of maternal nutrition and glycaemic control, and consideration of prophylactic tocolysis or corticosteroid administration when preterm birth risk is imminent. Minimally invasive fetoscopic laser ablation has transformed outcomes in established twin-to-twin transfusion syndrome, whilst selective reduction may be indicated in higher-order multiples to improve twin survival. Delivery planning balances the risks of prolonged intrauterine gestation against those of neonatal prematurity, with current consensus favouring delivery around 36 weeks for monochorionic and 37 weeks for dichorionic gestations. Global disparities in resource availability underscore the need for adaptable frameworks that integrate basic ultrasound capacity and multidisciplinary care to optimise outcomes in diverse settings.

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Management of Twin Pregnancies and Related Conditions publication trend

The graph below shows the total number of articles in management of twin pregnancies and related conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Chorionicity: Classification based on the number of chorionic membranes, determining placental sharing in multiple pregnancies.

Monochorionic diamniotic: Twin pregnancy in which both foetuses share a single chorion but have separate amniotic sacs.

Dichorionic diamniotic: Twin pregnancy in which each foetus has its own chorion and amniotic sac.

Selective foetal growth restriction (sFGR): Discrepant growth in monochorionic twins, where one foetus fails to achieve expected intrauterine growth.

Twin-to-twin transfusion syndrome (TTTS): Vascular anastomoses in a shared placenta leading to unbalanced blood flow between monochorionic twins.

Placental abruption: Premature separation of the placenta from the uterine wall, often precipitating perinatal morbidity or mortality.

References

1. Metabolic dynamics and prediction of sFGR and adverse fetal outcomes: a prospective longitudinal cohort study. BMC Medicine (2023).
2. Placental abruption and perinatal mortality in twins: novel insight into management at preterm versus term gestations. European Journal of Epidemiology (2024).
3. ISUOG Practice Guidelines (updated): role of ultrasound in twin pregnancy. Ultrasound in Obstetrics and Gynecology (2025).
4. Pregnancy and obstetric outcomes of dichorionic triamniotic triplet pregnancies with selective foetal reduction after assisted reproductive technology. Reproductive Biology and Endocrinology (2024).
5. Intrauterine fetoscopic laser surgery versus expectant management in stage 1 twin-to-twin transfusion syndrome: an international randomized trial. American Journal of Obstetrics and Gynecology (2020).