Monochorionic twin pregnancy

30 yr old primigravida at 30.4 weeks with DAMC twin pregnancy Chief Complaints complaints of decreased fetal movements. Physical Examination Per abdomen 32-34 weeks. relaxed . both fetal heart present. Investigations ultrasound showing decreased flow in umbilical artery in twin 1. EFBW 1Kg 2nd twin normal doppler 1.3 kg. liquor 18 Diagnosis Kindly opine on further management.

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This is DAMC pregnancy, now we need to differentiate whether it is Discordant growth or TTTS , FOR this amniotic fluid measurement in normal foetus is important . Now it is 31 wks so for expectant management to consider intensive antepartum fetal surveillance is necessary & any evidence of fetal compromise warrants immediate delivery. Middle cerebral artery ( MCA ) doppler may help now further. In general such pregnancies are best terminated as soon as the other twin is capable of extaruterine SURVIVAL.

Report is normal Artery removes waste Generally one artery one vein in twin pregnancy

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