As the saying goes, many children are blessed. How blessed it would be to have two or more children at once. “In fact, the risk of twin or multiple pregnancies is much greater than that of singleton pregnancies.” Twin pregnancies, especially monozygotic twins, have an increased chance of fetal complications due to sharing a placenta with vascular traffic anastomoses. Therefore, ultrasound should be performed during 6-14 weeks of gestation to determine chorionicity, and biweekly ultrasound starting at 16 weeks of gestation to monitor fetal growth, blood flow, and amniotic fluid for early detection of abnormalities and early diagnosis and treatment. Miracle of life: Successful treatment of babies with “twin fetus transfusion syndrome” Xiao Jia’s family from Shandong province now has two tiger-headed, playful and cute baby boys. But just four months ago, they were still overwhelmed and anxious about the sudden blow. In July, the twins were found to be one bigger and one smaller during an ultrasound at 25 weeks of pregnancy, and the amniotic fluid volume of the two children differed a lot. The doctor initially diagnosed a common complication of monozygotic twins – twin fetus transfusion syndrome. This means that the smaller fetus is constantly transfusing blood to the larger fetus, which grows smaller and smaller, while the larger fetus is forced to receive large amounts of blood and gradually develops fetal edema. This disease has a local colloquialism called “a child eating another child’s blood”, due to the lack of awareness of this disease, many pregnant women suffering from this disease have chosen to induce abortion, which is simply unacceptable for the 27-year-old Xiao Jia. The couple has been married for more than two years wanting to have children, and now it is easy to get pregnant, or twins, they feel that these two children are incredibly precious. After asking around and looking online, Jia found a doctor and rushed to Beijing overnight with her husband. After a series of tests at Beihang Hospital, Xiao Jia was diagnosed with twin-birth transfusion syndrome stage IV. A team of obstetricians from Beihang Hospital immediately consulted and determined the treatment plan, which was to use fetoscopic laser electrocoagulation placental anastomosis vascularization to coagulate the blood exchange “channel” between the two children. When Jia’s husband learned that the baby was saved, he cried tears of joy at the entrance of the clinic. The surgery involved identifying different types of anastomosed vessels under the fetoscope and selectively coagulating them, some of which were only 1 mm in diameter, making the surgery difficult to imagine. Because it was an emergency surgery, Xiao Jia was pushed into the operating room the next day and the surgery went well. After the operation, Xiao Jia and her family stayed temporarily in Beijing and went to the hospital for regular maternity checkups, eventually delivering two healthy baby boys by cesarean section. Common complications of monozygotic twin pregnancies Twins are generally divided into dizygotic twins and monozygotic twins. The former is a double chorionic villus with two amniotic sacs, which means that there are two placentas and independence is relatively good, while the latter is divided into double chorionic villus with two amniotic sacs, single chorionic villus with two amniotic sacs and single chorionic villus with single amniotic sacs, of which both single chorionic villus with two amniotic sacs and single chorionic villus with single amniotic sacs share one placenta, and 80-90% of the blood vessels between the two fetuses are connected, making them prone to complications. Dr. Wang Xueju said that clinically, there are three common complications of monochorionic twin fetuses: 1. Twin-Transfusion Syndrome (TTTS) Based on ultrasound diagnostic criteria during pregnancy, one fetus with too much amniotic fluid (the recipient) and one with too little amniotic fluid (the donor) appear in monochorionic twin pregnancies. The donor has to transfuse blood to the recipient in addition to its own needs and therefore may suffer from anemia, intrauterine growth restriction and low amniotic fluid. The recipient, on the contrary, is constantly receiving transfusions from the donor and is overloaded with circulating blood, with signs of polycythemia, high blood viscosity, high blood pressure, cardiomegaly, subcutaneous edema of the skin, and excessive amniotic fluid. In monochorionic twin pregnancies, about 10% of pregnancies are complicated by twin transfusion syndrome during pregnancy, with onset of gestational weeks usually between 16 and 26 weeks. If this condition is not treated aggressively, the rate of loss of both fetuses is as high as 80-100%. 2. Twin fetus anemia-erythropoietic sequence (TAPS) usually starts at 20 weeks of gestation when one fetus transfuses the other, manifesting as anemia in one fetus and increased red blood cells and viscous blood in the other fetus. This disease is a chronic transfusion, usually the transfusion occurs between thinner vessels, so thin that only red blood cells are allowed to pass in one direction, and the recipient child has more and more red blood cells, while the donor child has less and less, thus triggering anemia in the donor child, and the two children are born with very different hematocrit. 3. Selective intrauterine growth restriction (SIUGR) One of the twin fetuses is growth restricted and the fetal weight is estimated by ultrasound to be below the 10th percentile of the corresponding gestational week, with a 25% difference in weight between the two fetuses and a lack of growth potential in the smaller fetus. If we compare the placenta to a large pie, where the larger fetus occupies 2/3 or more of the placenta and the smaller fetus is only at the edge of the placenta, the blood supply to the smaller fetus is relatively reduced and around 20 weeks the blood supply becomes insufficient and growth slows down, resulting in an increasing weight difference between the two children. Three treatments Doctors do ultrasound exams for twin mothers-to-be Although there are many risks in twin pregnancies, statistics show that twin pregnancies account for about 70% of dizygotic twins, both with double chorionic villi; monozygotic twins account for about 30%, and it should be said that most twins are still healthy. Dr. Wang Xueju emphasized that even in case of complicated twin pregnancy complications mentioned above, there are relatively effective treatment measures. For example, the twin pregnancy transfusion syndrome can be treated by fetoscopic laser treatment at 18-26 weeks of gestation, and Beihang Hospital is the first hospital in China to successfully complete this procedure, and has completed more than 80 cases of fetoscopic laser coagulation placental anastomosis vascularization, with more than 60 successful cases. 1.Fetoscopic laser coagulation placental anastomosis angioplasty (FLOC) Fetoscopic laser coagulation placental anastomosis angioplasty has now become the first-line choice for the treatment of twin-fetus transfusion syndrome. Different types of anastomotic vessels are identified under fetoscopy and selectively coagulated to block the superficial placental anastomotic vessels in an attempt to preserve both fetuses. An equatorial line is formed on the superficial placental chorionic plate to functionally segment the placenta into two parts with the aim of reducing the incidence of residual vessels postoperatively. This method is indicated for the three complications mentioned above. 2. Amniotic fluid reduction amniotic fluid reduction can improve the blood flow in the uterine artery and reduce the pressure in the amniotic cavity to a certain extent. On the one hand, it can relieve the increased uterine tension, abdominal distension and even contractions caused by excessive amniotic fluid, and on the other hand, it can improve the pregnancy outcome of patients with twin-birth transfusion syndrome to a certain extent. However, this method can treat the symptoms but not the root cause, and has a high recurrence rate, and is only suitable for early stage patients with twin-fetus transfusion syndrome. 3.Selective reduction of fetus Under ultrasound guidance, radiofrequency ablation, bipolar electrocoagulation or umbilical cord ligation under fetoscopy is applied to block the blood flow of the umbilical cord to reduce the small fetus and avoid the possible neurological damage of the large fetus due to acute blood loss caused by sudden intrauterine death of the small fetus, and to protect the large fetus and prolong its termination week to a certain extent. The procedure is relatively simple and the postoperative live birth rate is 80-85%.