We conducted a search for international clinical guidelines related to prenatal screening during monochorionic pregnancies. We found 25 resources from 13 countries/regions and extracted information ...related to general screening as well as screening related to specific monochorionic complications, including twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (SFGR), and twin anemia-polycythemia sequence (TAPS). Findings reveal universal recommendation for the early establishment of chorionicity. Near-universal recommendation was found for bi-weekly ultrasounds beginning around gestational week 16; routine TTTS and SFGR surveillance comprised of regularly assessing fetal growth, amniotic fluids, and bladder visibility; and fetal anatomical scanning between gestational weeks 18-22. Conflicting recommendation was found for nuchal translucency screening; second-trimester scanning for cervical length; routine TAPS screening; and routine umbilical artery, umbilical vein, and ductus venosus assessment. We conclude that across international agencies and organizations, clinical guidelines related to monochorionic prenatal screening vary considerably. This discord raises concerns related to equitable access to evidence-based monochorionic prenatal care; the ability to create reliable international datasets to help improve the quality of monochorionic research; and the promotion of patient safety and best monochorionic outcomes. Patients globally may benefit from the coming together of international bodies to develop inclusive universal monochorionic prenatal screening standards.
Monochorionic-diamniotic (MCDA) pregnancies are high-risk necessitating ongoing screening for serious complications and quick decision-making. COVID-19 pandemic protocols introduced unique challenges ...to pregnancy management and patient experience. In late 2021, an online, mixed-methods, cross-sectional survey recruited 561 participants who experienced an MCDA pregnancy within five years. Analyses included descriptive and bivariate statistics and thematic analysis. Findings suggest the pandemic did not negatively affect screening/diagnosis for these participants. Care consistent with guidelines was received by most, with care slightly better during the pandemic. Almost 80% (79.0%) received an MCDA diagnosis by gestational week 14 before the pandemic, 87.8% during. Most received biweekly ultrasounds, 88.0% prior to the pandemic, 88.9% during. Experiences were affected in other ways for almost 44% of participants pregnant during COVID-19; in ways likely shared by other high-risk pregnancies. Thematic analysis revealed management during COVID-19 impacted self-advocacy and emotions (eg, alienation, anxiety), made care seem impersonal, and resulted in delayed or canceled appointments. Policies should be considered, so future healthcare disruptions do not impact patients and preserve in-person health care with access to a support person.
In the United States, routine middle cerebral artery peak systolic velocity (MCA-PSV) Doppler screening for the detection of antenatal twin anemia-polycythemia sequence (TAPS) is not recommended. The ...current and only national clinical guideline from the highly-influential Society for Maternal-Fetal Medicine states that, "There is no evidence that monitoring for TAPS with MCA PSV Doppler at any time, including > 26 weeks, improves outcomes, so that this additional screening cannot be recommended at this time." We argue this recommendation has disproportionate influence on patients and the care they are offered and receive. We use current evidence to highlight and dispel pervasive myths surrounding antenatal TAPS and the value of routine MCA-PSV screening. An ethical framework that illustrates the importance of giving patients the opportunity for routine screening is presented. Findings demonstrate that: (1) both spontaneous and post-laser TAPS is a serious, potentially life-threatening complication, (2) treatment for TAPS is effective and includes expectant management, intrauterine transfusion (IUT), or surgery, (3) and routine MCA-PSV, which has satisfactory diagnostic accuracy, is currently the only way to provide early detection of TAPS. We conclude that routine TAPS screening is a medically proven valuable resource that should be offered to patients in need and to the clinicians who are trying to act toward their benefit.
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