Review of international clinical guidelines related to prenatal screening during monochorionic pregnancies.
AMNIOTIC liquid; clinical guidelines; FETAL growth retardation; monochorionic twin pregnancy; PREGNANCY; PRENATAL care; screening; UMBILICAL arteries
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.
Nicholas L; Fischbein R; Ernst-Milner S; Wani R
Journal Of Clinical Medicine
2021
2021-03-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.3390/jcm10051128" target="_blank" rel="noreferrer noopener">10.3390/jcm10051128</a>
Dispelling Myths about Antenatal TAPS: A Call for Action for Routine MCA-PSV Doppler Screening in the United States
anemia-polycythemia sequence; cerebral-artery; clinical guidelines; diagnostic-criteria; fetal; General & Internal Medicine; laser-surgery; MCA-PSV Doppler; middle; monochorionic diamniotic twin pregnancy; peak systolic velocity; perinatal management; placental echogenicity; prevalence; screening; TAPS; twin anemia-polycythemia sequence; twin transfusion syndrome
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.
Nicholas Lauren; Fischbein Rebecca; Aultman Julie; Ernst-Milner Stephanie
Journal of Clinical Medicine
2019
2019-07
<a href="http://doi.org/10.3390/jcm8070977" target="_blank" rel="noreferrer noopener">10.3390/jcm8070977</a>