Double trouble: A case series exploring the complications of twin pregnancy

Monochorionic twin pregnancies are associated with unique and serious complications due to shared placental circulation, including twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), and twin reversed arterial perfusion (TRAP) sequence. This case series presents four monochorionic diamniotic pregnancies complicated by TAPS, TTTS (Quintero stages I and IV), and TRAP. Diagnostic features such as intertwin discrepancies in middle cerebral artery peak systolic velocity, amniotic fluid discordance, and Doppler studies were critical in identifying these conditions. Management strategies included conservative monitoring, radiofrequency ablation, and, in one case, termination due to poor prognosis. Outcomes varied, highlighting the unpredictable nature of these conditions despite timely intervention. This study underscores the importance of early chorionicity determination, regular ultrasound monitoring, and individualized multidisciplinary care in optimizing outcomes for monochorionic twin pregnancies.