Diagnosis of twin-to-twin transfusion syndrome, selective fetal growth restriction, twin anaemia-polycythaemia sequence, and twin reversed arterial perfusion sequence

Monochorionic twin pregnancies are well known to be at risk for a variety of severe complications, a true challenge for the maternal–fetal medicine specialist. With current standards of care, monochorionicity should be established in the first trimester. Subsequently, frequent monitoring using the appropriate diagnostic tools, and in-depth knowledge about the pathophysiology of all possible clinical presentations of monochorionic twin abnormalities, should lead to timely recognition, and appropriate management. Virtually all unique diseases found in monochorionic twins are directly related to placental angio-architecture. This, however, cannot be established reliably before birth. The clinician needs to be aware of the definitions and symptoms of twin-to twin transfusion syndrome, selective fetal growth restriction, twin anaemia–polycythaemia sequence, and twin reversed arterial perfusion sequence, to be able to recognise each disease and take the required action.In this chapter, we address current standards on correct and timely diagnoses of severe complications of monochorionic twin pregnancies.