Perth, Australia & Toronto, ON.
Toronto, ON.
J Obstet Gynaecol Can. 2023 Aug;45(8):587-606.e8. doi: 10.1016/j.jogc.2023.05.018.
This guideline reviews the evidence-based management of normal and complicated monochorionic twin pregnancies.
Women with monochorionic twin or higher order multiple pregnancies.
BENEFITS, HARMS, AND COSTS: Implementation of these recommendations should improve the management of both complicated and uncomplicated monochorionic (and higher order multiple) twin pregnancies. They will help users monitor monochorionic twin pregnancies appropriately and identify and manage monochorionic twin complications optimally in a timely manner, thereby reducing perinatal morbidity and mortality. These recommendations entail more frequent ultrasound monitoring of monochorionic twins compared to dichorionic twins.
Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate MeSH headings (Twins, Monozygotic; Ultrasonography, Prenatal; Placenta; Fetofetal Transfusion; Fetal Death; Fetal Growth Retardation). Results were restricted to systematic reviews, randomized controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials.
The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).
Maternal-fetal medicine specialists, obstetricians, radiologists, sonographers, family physicians, nurses, midwives, residents, and other health care providers who care for women with monochorionic twin or higher order multiple pregnancies.
Canadian (SOGC) guidelines for the diagnosis, ultrasound surveillance and management of monochorionic twin pregnancy complications, including TTTS, TAPS, sFGR (sIUGR), acardiac (TRAP), monoamniotic twins and intrauterine death of one MC twin.
RECOMMENDATIONS.
本指南旨在回顾基于循证医学的正常和复杂的单绒毛膜双胎妊娠管理。
单绒毛膜或更高序多胎妊娠的女性。
获益、危害和成本：这些建议的实施应改善复杂和简单的单绒毛膜（和更高序多胎）双胎妊娠的管理。它们将帮助用户适当监测单绒毛膜双胎妊娠，并及时识别和处理单绒毛膜双胎妊娠并发症，从而降低围产期发病率和死亡率。与双绒毛膜双胎妊娠相比，这些建议需要更频繁地对单绒毛膜双胎进行超声监测。
通过使用适当的 MeSH 标题（双胞胎，单卵；超声检查，产前；胎盘；胎胎输血；胎儿死亡；胎儿生长迟缓）在 PubMed 和 Cochrane 图书馆中检索已发表的文献。结果仅限于系统评价、随机对照临床试验和观察性研究。没有时间限制，但结果仅限于英语或法语材料。
主要作者起草并同意了内容和建议。SOGC 委员会批准了最终草案供出版。作者使用推荐评估、制定和评价（GRADE）方法评估证据质量和建议强度。请参见在线附录 A（表 A1 用于定义，表 A2 用于强推荐和条件性 [弱]推荐的解释）。
关注单绒毛膜双胎或更高序多胎妊娠的母胎医学专家、产科医生、放射科医生、超声科医生、家庭医生、护士、助产士、住院医师和其他医疗保健提供者。
加拿大（SOGC）关于单绒毛膜双胎妊娠并发症的诊断、超声监测和管理指南，包括 TTTS、TAPS、sFGR（sIUGR）、无心畸形（TRAP）、单羊膜双胎和单绒毛膜双胎之一的宫内死亡。
建议。
