Interview Questions for Multiple Pregnancy Management

My experience managing multiple pregnancies spans over 15 years, encompassing a wide range of gestation types, from twins to quintuplets. I’ve worked in high-risk obstetrics units and collaborated extensively with neonatologists and other specialists. This experience has given me a comprehensive understanding of the unique challenges and complexities involved, enabling me to provide personalized, evidence-based care. I’ve overseen hundreds of multiple pregnancies, focusing on proactive management strategies to minimize risks and optimize outcomes for both mothers and babies. Each case is different, requiring careful assessment and tailored plans. For example, I recently managed a triplet pregnancy complicated by twin-to-twin transfusion syndrome (TTTS), requiring specialized interventions and close monitoring, leading to a successful outcome.

Multiple pregnancies inherently carry increased risks compared to singleton pregnancies. These risks escalate with the number of fetuses.

• Twin pregnancies: Increased risk of preeclampsia, gestational diabetes, preterm labor, placental abruption, postpartum hemorrhage, and fetal growth restriction. One twin may grow significantly larger than the other (discordant growth).
• Triplet and higher-order pregnancies: The risks associated with twin pregnancies are amplified significantly. The chance of preterm birth becomes drastically higher, along with a greater likelihood of low birth weight babies, respiratory distress syndrome, and other neonatal complications. The mother’s risk of serious complications, such as preeclampsia and gestational diabetes, increases exponentially.

The underlying reason for the increased risk is the physiological strain placed on the mother’s body by carrying multiple fetuses. The uterus expands significantly, putting pressure on internal organs, and the demand for nutrients and blood flow is much higher than in singleton pregnancies.

Common complications in multiple pregnancies include preterm labor, preeclampsia, gestational diabetes, fetal growth restriction, twin-to-twin transfusion syndrome (TTTS) in twins, and placental abnormalities.

• Preterm labor: Managed with bed rest, tocolytics (medications to stop contractions), and potentially corticosteroids to enhance fetal lung maturity.
• Preeclampsia/Gestational Hypertension: Close monitoring of blood pressure, urine protein levels, and fetal well-being. Management may involve medication, modified bed rest, and in severe cases, early delivery.
• Gestational Diabetes: Careful monitoring of blood sugar levels, dietary adjustments, and potentially insulin therapy.
• Fetal Growth Restriction: Serial ultrasounds to assess growth, and close monitoring for signs of fetal distress. May require early delivery.
• TTTS: This serious condition requires specialized intervention, potentially including laser surgery to reduce blood vessel connections between the placentas.
• Placental Abnormalities: Depending on the nature of the abnormality, management may include close monitoring or intervention such as blood transfusions if there’s significant bleeding.

Management involves a multidisciplinary approach, including obstetricians, perinatologists, neonatologists, and other specialists, tailored to the specific needs of the mother and fetuses.

Fetal monitoring in multiple pregnancies is crucial and more intensive than in singleton pregnancies. We utilize a combination of techniques:

• Non-stress tests (NSTs): Regularly performed to assess fetal heart rate reactivity and response to fetal movement.
• Biophysical profiles (BPPs): Combining NST with ultrasound assessment of fetal breathing movements, fetal movement, amniotic fluid volume, and fetal tone. A comprehensive picture of fetal well-being.
• Ultrasound: Regular ultrasounds, often weekly or bi-weekly in high-risk pregnancies, to assess fetal growth, placental position, amniotic fluid volume, and detect any complications.
• Doppler studies: Used to assess blood flow in the umbilical arteries and fetal vessels, to detect any signs of fetal growth restriction or placental insufficiency.

The frequency and type of monitoring depend on the gestational age, the presence of any risk factors, and the overall health of both the mother and the fetuses. In cases of high risk, such as twin-twin transfusion syndrome, continuous fetal monitoring may be required.

Assessment of fetal growth and development in multiple gestations relies heavily on regular ultrasound scans. We use biometric measurements (head circumference, abdominal circumference, femur length) to estimate fetal weight and compare it to gestational age. We also look for signs of discordant growth, where one twin is significantly smaller than the other. Serial measurements are essential to track growth patterns and identify any deviations from the norm.

Growth restriction in one or more fetuses might indicate placental insufficiency or other underlying problems. Such situations would require additional testing and potentially earlier delivery. We might also use Doppler studies to assess blood flow in umbilical and fetal vessels, providing further insights into fetal well-being. Additionally, amniotic fluid levels are observed for polyhydramnios (excess fluid) or oligohydramnios (low fluid), both indicators of potential problems.

Ultrasound is indispensable in managing multiple pregnancies. It’s the primary tool for:

• Early detection of complications: Identifying problems like TTTS, fetal growth restriction, placental abnormalities, and structural anomalies early in the pregnancy, allowing for timely intervention.
• Fetal growth monitoring: Tracking fetal growth throughout gestation and detecting any signs of asymmetry or growth restriction.
• Assessment of amniotic fluid: Determining amniotic fluid volume which is crucial for overall fetal well-being.
• Placental assessment: Evaluating the location and structure of the placentas, which can affect the overall management of the pregnancy.
• Fetal presentation: Determining the position of each fetus as the pregnancy progresses to help plan for delivery.

The frequency of ultrasounds is typically increased in multiple pregnancies, often beginning in early gestation and continuing until delivery.

Preeclampsia and gestational diabetes are significantly more common and severe in multiple pregnancies. Preeclampsia, characterized by high blood pressure and protein in the urine, poses a serious threat to both the mother and the fetuses. It often requires close monitoring, medication, and sometimes early delivery to protect both mother and babies. Gestational diabetes, impacting blood sugar regulation, increases the risk of large babies, birth injuries, and future health issues for both mother and child. Strict blood sugar monitoring, dietary changes, and insulin therapy might be needed. Both conditions necessitate intensified monitoring and management in multiple gestations, often involving frequent appointments and specialized care.

For example, a patient with severe preeclampsia carrying twins may require hospitalization for close monitoring and management, potentially including medication to lower blood pressure and prevent seizures. Careful weighing of the risks of continuing the pregnancy versus the risks of early delivery is necessary in these cases. This decision-making is nuanced and personalized, taking into account fetal maturity and the severity of maternal complications.

Counseling patients about delivery methods in multiple pregnancies requires a thorough understanding of their individual circumstances and the risks and benefits of each approach. We begin by explaining that the ideal delivery method depends on factors such as gestational age, fetal presentation (e.g., breech, transverse), placental location, fetal growth and health, and the mother’s overall health.

Vaginal Delivery: While vaginal delivery is generally preferred for twins, it’s not always possible, especially in triplets or higher-order multiples or if there are complications. We discuss the potential benefits, including shorter recovery times and reduced risk of infection compared to Cesarean section. However, we also highlight risks like increased risk of postpartum hemorrhage, uterine rupture (rare but serious), and potential complications for the babies (e.g., shoulder dystocia).

Cesarean Section: A Cesarean section (C-section) is often recommended for breech presentations, placental previa (placenta covering the cervix), or other complications. We explain that C-sections can help prevent complications for both mother and babies but involve longer recovery times, increased risk of infection, and potential complications such as bleeding or adhesion formation. We carefully weigh the benefits and risks of each approach tailored to the individual patient’s situation.

Elective Cesarean vs. Trial of Labor: For some twin pregnancies, a trial of labor may be considered. This involves closely monitoring the mother and babies during labor, ready to intervene with a C-section if necessary. We discuss the benefits and risks of both elective Cesarean section and trial of labor, emphasizing shared decision-making and empowering the patient to participate actively in planning her delivery.

For example, a patient carrying twins, one breech and one vertex, might be a candidate for a trial of labor if the breech twin is appropriately positioned and other factors are favorable. However, if there are additional complications like placental abnormalities, a C-section would likely be recommended.

Managing preterm labor in multiple gestations is a critical area requiring immediate and aggressive intervention. Preterm birth is a significant risk factor in multiple pregnancies, often occurring before 37 weeks of gestation. Our approach is multifaceted and begins with accurate diagnosis.

Diagnosis and Assessment: We meticulously assess the patient, including checking for uterine contractions, cervical changes (shortening and dilation), and fetal heart rate patterns. We also consider risk factors like previous preterm birth, infection, and underlying medical conditions.

Treatment Strategies: The goal is to delay delivery as long as possible to allow the babies to mature. Strategies include:

• Bed rest: While its efficacy is debated, bed rest can sometimes reduce uterine activity.
• Tocolytics: Medications such as magnesium sulfate or indomethacin can help suppress uterine contractions. Careful monitoring of maternal and fetal wellbeing is crucial here, considering potential side effects.
• Corticosteroids: Administering corticosteroids to the mother accelerates fetal lung maturation, reducing the risk of respiratory distress syndrome in premature infants.
• Infection Treatment: Treating any underlying infection is crucial to prevent further complications.
• Hydration and electrolyte balance: Maintaining optimal hydration and electrolyte balance minimizes stress on the mother’s body.

Close Monitoring: Frequent monitoring of the mother and fetuses using fetal monitoring, ultrasound, and other assessments is paramount. This ensures prompt detection of any worsening condition requiring immediate action.

For example, a patient presenting with preterm labor at 32 weeks gestation will likely receive corticosteroids to hasten fetal lung development, and tocolytics to suppress contractions. Close monitoring and a multidisciplinary approach (obstetrician, neonatologist, nurses) is crucial for the best outcome.

Coordinating care among specialists during a multiple pregnancy is essential for optimal outcomes. This involves a highly collaborative approach involving various medical professionals.

Key Specialists: Typically, the team includes an obstetrician, a maternal-fetal medicine specialist (MFM), a neonatologist, and often a perinatologist. Additional specialists may be involved based on individual circumstances, including a high-risk pregnancy nurse, a dietician, and a psychologist.

Communication and Collaboration: Regular communication and coordination are essential among the specialists. We utilize electronic health records (EHRs), shared medical platforms, and regular team meetings to maintain open communication. This ensures everyone is aware of the latest developments and treatment plans.

Shared Decision-Making: Decisions regarding treatment and management strategies are typically made through shared decision-making involving the patient and all relevant medical professionals. The patient is actively involved in making choices based on the information provided.

Example: In a case of twin pregnancy with one twin exhibiting intrauterine growth restriction (IUGR), the obstetrician, MFM specialist, and neonatologist would collaborate closely to monitor fetal growth, plan for potential interventions (e.g., delivery timing), and determine the best approach for managing the pregnancy and potential neonatal care needs. The dietitian would also ensure the mother receives proper nutritional guidance for supporting both fetal growth and her own health.

Postpartum care for mothers of multiples is particularly crucial due to the increased physical and emotional demands. We provide comprehensive care addressing both the physical and psychological aspects of recovery.

Physical Recovery: We monitor for postpartum hemorrhage, infection, and other complications which are more common in multiple births. We emphasize proper wound care (if a C-section was performed), adequate pain management, and nutritional support. Lactation consultants can offer guidance on breastfeeding multiples, which may present unique challenges.

Emotional Wellbeing: Postpartum depression (PPD) and anxiety are significantly more prevalent in mothers of multiples. We screen for these conditions early on and offer appropriate support. This can include referrals to mental health professionals, support groups, and counseling.

Practical Support: Providing practical guidance on managing the logistics of caring for multiples, such as feeding, diapering, and sleep routines is also an integral part of postpartum care. We often collaborate with social workers and home health nurses to ensure the mother has the necessary support system at home. For instance, home visits by a nurse may be arranged to assist with monitoring the mother and babies’ health and providing essential practical assistance.

Long-term Follow-up: Long-term follow-up appointments are scheduled to monitor the mother’s physical and mental health and address any ongoing challenges.

Nutritional guidance is paramount in multiple pregnancies due to the increased metabolic demands on the mother’s body. Adequate nutrition supports fetal growth, reduces the risk of preterm labor, and improves maternal health.

Calorie and Nutrient Requirements: Women with multiple pregnancies require a significantly higher caloric intake and increased intake of essential nutrients compared to singleton pregnancies. We recommend a personalized diet plan that addresses this increased need. The recommended daily increase varies depending on the number of fetuses, gestational age, and individual needs.

Essential Nutrients: Emphasis is placed on increasing the intake of:

• Protein: For fetal growth and tissue repair.
• Iron: To prevent anemia, a common complication in multiple pregnancies.
• Folic acid: To prevent neural tube defects.
• Calcium: For bone health and fetal skeletal development.
• Vitamin D: For calcium absorption and immune function.

Weight Management: While adequate weight gain is crucial, excessive weight gain should be avoided. We provide guidance on making healthy food choices and portion control.

Hydration: Adequate hydration is also very important. We emphasize drinking plenty of water throughout the day.

Individualized Plans: We create personalized nutrition plans that consider individual preferences, dietary restrictions, and potential medical conditions.

Mothers of multiples often face unique psychological challenges. Addressing these is a critical component of multiple pregnancy management.

Common Challenges: These can include anxiety about the health of the babies, concerns about managing a large family, fear of preterm labor, financial worries, and the potential for postpartum depression or anxiety.

Assessment and Support: We actively screen for anxiety and depression throughout the pregnancy and postpartum period. We assess the mother’s coping mechanisms and provide support through various strategies:

• Psychoeducation: Providing information about common challenges and effective coping strategies.
• Individual or group therapy: Referral to mental health professionals for individual or group therapy.
• Support Groups: Connecting mothers with others experiencing similar situations.
• Stress Management Techniques: Teaching relaxation techniques, such as mindfulness or deep breathing exercises.

Partner Involvement: Involving the partner or support network in the counseling process is essential, as the entire family’s well-being is affected.

Example: A mother experiencing overwhelming anxiety about managing twins might benefit from attending a support group, learning stress reduction techniques, and accessing additional practical assistance through home health services.

Neonatal intensive care unit (NICU) concerns for multiples are significantly higher than for singletons due to the increased risk of prematurity and other complications.

Common Concerns:

• Respiratory Distress Syndrome (RDS): Premature babies often lack sufficient surfactant in their lungs, leading to breathing difficulties. This is especially prevalent in multiples.
• Intraventricular Hemorrhage (IVH): Bleeding in the brain is more common in preterm infants, particularly multiples.
Bronchopulmonary Dysplasia (BPD): Chronic lung disease that can develop in babies who require prolonged mechanical ventilation.
• Necrotizing Enterocolitis (NEC): A serious intestinal condition that primarily affects preterm infants.
• Growth Restriction: One or more twins might experience restricted growth in the womb.
• Twin-to-Twin Transfusion Syndrome (TTTS): A serious complication in identical twins, where unequal blood flow occurs between the fetuses.

Individualized Care: Each baby’s needs are carefully assessed and monitored upon admission to the NICU. The neonatologist and NICU team create individualized care plans to address their specific concerns.

Parental Involvement: Parental involvement in the NICU is crucial. We work to ensure parents receive comprehensive information, emotional support, and training in caring for their babies once they are ready to go home.

Long-term Follow-up: Long-term follow-up appointments are essential, as some multiples may experience developmental delays or other health issues requiring ongoing medical attention.

Assisted Reproductive Technology (ART), such as in-vitro fertilization (IVF), significantly increases the chance of multiple pregnancies. While ART offers hope for many couples struggling with infertility, it also presents unique challenges. The use of hormonal stimulation during IVF often leads to the release of multiple eggs, increasing the likelihood of multiple fertilization and implantation. My experience involves carefully counseling patients undergoing ART about the risks and benefits of multiple gestation, including the higher likelihood of premature birth, low birth weight, and other complications. We discuss strategies to minimize this risk, such as selective embryo transfer (transferring fewer embryos), but ultimately, the decision rests with the patient. For example, a patient might choose a higher chance of pregnancy with a higher risk of multiples versus a lower chance with a single embryo transfer. We carefully weigh these options together.

Communicating complex medical information to patients with multiple pregnancies requires a sensitive and empathetic approach. I start by assessing the patient’s understanding of medical terminology and tailoring my explanations accordingly. I use clear, simple language, avoiding jargon whenever possible. I often employ visual aids like ultrasound images and diagrams to illustrate key concepts. For example, when explaining the risks of TTTS (twin-to-twin transfusion syndrome), I’ll use an analogy of two connected water bottles, explaining how an imbalance in blood flow can harm one twin more than the other. I encourage questions throughout the conversation and ensure the patient feels comfortable expressing their concerns. Involving family members in these discussions can also be incredibly beneficial, particularly when making difficult decisions. Finally, I provide comprehensive written materials summarizing our discussion points for future reference.

Fetal reduction is a complex procedure where one or more fetuses are selectively terminated in a multiple pregnancy. It’s typically considered when there’s a high risk of complications associated with carrying multiple fetuses to term, such as dangerously high order multiples (e.g., quintuplets) or severe complications like twin-to-twin transfusion syndrome (TTTS) that threaten the survival of all fetuses. The procedure is performed under ultrasound guidance using either injection of potassium chloride into the fetal heart or surgical removal. The implications are profound, both medically and emotionally. Medically, it aims to improve the chances of survival and health for the remaining fetuses. Emotionally, it’s a very difficult decision for parents, and I offer extensive counseling and support before, during, and after the procedure. I ensure patients understand all aspects, including potential risks and complications, and they have ample time to consider their options before making this incredibly difficult choice.

Placental abnormalities in multiple pregnancies are common and can significantly impact fetal health. These abnormalities include monochorionic pregnancies (where the twins share a placenta), which increase the risk of TTTS and selective intrauterine growth restriction (sIUGR), and dichorionic pregnancies (where twins have separate placentas) but can still have complications like placental abruption or previa. My approach involves close monitoring with regular ultrasounds to assess placental structure and function. Doppler studies are used to evaluate blood flow within the placenta and umbilical cords. If abnormalities are detected, I adjust the management plan, which may include increased fetal monitoring, hospitalization for close observation, and potential intervention depending on the severity of the abnormality. For example, early detection of TTTS requires prompt intervention, potentially laser ablation of placental vessels. Each case requires a personalized approach based on the specific placental abnormality and the overall health of the fetuses and mother.

Determining the optimal gestational age for delivery in multiple gestations is crucial. It’s a balance between the risks of prematurity and the risks of continuing the pregnancy. Several factors are considered including the gestational age, fetal growth, fetal lung maturity (assessed through amniocentesis), placental function, and presence of any pregnancy complications. For example, in twin pregnancies, delivery might be considered between 35 and 37 weeks if there are no complications. However, in triplet pregnancies, the gestational age at delivery is usually earlier due to the higher risk of prematurity and complications. I closely monitor fetal growth and well-being throughout the pregnancy and consult with neonatologists to ensure the best possible outcome for both the mother and infants. Serial ultrasounds and biophysical profiles provide valuable data to guide this critical decision.

Postpartum hemorrhage (PPH) is a significant risk in multiple pregnancies due to uterine atony (the inability of the uterus to contract effectively after delivery). My strategies for preventing and managing PPH include prophylactic administration of uterotonics (medications that stimulate uterine contractions) immediately after delivery of the last fetus. I also meticulously monitor blood loss and vital signs during and after delivery. If PPH occurs, I utilize a stepwise approach that may involve administering additional uterotonics, performing uterine massage, and considering other interventions such as balloon tamponade or surgical procedures (like uterine artery embolization or hysterectomy) as necessary. In addition, I ensure adequate blood product availability in case of significant blood loss. Early detection and prompt intervention are crucial in managing PPH and preventing maternal morbidity and mortality.

Twin-to-twin transfusion syndrome (TTTS) is a serious complication in monochorionic twin pregnancies where there’s an imbalance in blood flow between the twins through shared placental vessels. My approach to assessing and addressing TTTS involves regular ultrasounds, including Doppler studies of the umbilical vessels and placental vessels, to monitor the blood flow between the twins. A significant difference in amniotic fluid volume between the two sacs (polyhydramnios in one sac and oligohydramnios in the other) is a key indicator. If TTTS is diagnosed, the severity is classified according to the Quintero staging system. Depending on the severity, I will coordinate management with a team of specialists, including a maternal-fetal medicine specialist, a neonatologist, and a perinatologist. Treatment options may range from expectant management with close monitoring to fetal intervention, such as laser ablation of the abnormal placental vessels to equalize blood flow. The goal is to improve the chances of survival for both twins and minimize long-term complications. These cases require close collaboration, continuous monitoring, and prompt intervention.

Selective fetal reduction (SFR) is a complex procedure where one or more fetuses are removed from a multiple pregnancy to improve the chances of survival for the remaining fetuses. It’s a deeply emotional decision, and I only recommend it after extensive counseling and discussion with the parents. My experience involves guiding families through this process, ensuring they fully understand the risks and benefits, and providing ongoing support. This includes explaining the procedure itself, which involves using ultrasound guidance to inject potassium chloride into the fetal heart, causing a painless cessation of fetal activity. Post-procedure, close monitoring is crucial to detect and manage any potential complications, such as infection or bleeding. The psychological impact on parents is significant, and I always involve mental health professionals in the care plan to help parents cope with grief and guilt.

For example, I recently worked with a couple expecting sextuplets. The risks associated with carrying so many babies were extremely high, and after much deliberation, they chose to undergo SFR, reducing the pregnancy to triplets. This resulted in a healthier pregnancy and ultimately, three healthy babies.

Ethical considerations in multiple pregnancy management are paramount. The primary ethical dilemma revolves around balancing the well-being of all fetuses with the health and wishes of the parents. Decisions regarding SFR, for instance, are heavily laden with ethical weight. Informed consent is critical—parents must fully understand the risks and benefits of all interventions, including the option of doing nothing and accepting the potential risks associated with a high-order multiple pregnancy.

Another key ethical aspect is resource allocation. High-order multiple pregnancies often require extensive resources, prompting questions about the fair distribution of healthcare resources and equitable access to care. We must also navigate the complex emotional and psychological toll on parents, ensuring their well-being is prioritized throughout the decision-making process and beyond. My practice emphasizes open communication, shared decision-making, and a holistic approach to patient care that integrates ethical considerations at every stage.

Patient preferences are central to my treatment plan. I believe in a shared decision-making model, where I provide evidence-based information and guidance, but the ultimate choices rest with the parents. This involves active listening, empathetic communication, and a thorough understanding of their values, beliefs, and concerns.

For instance, some parents may prioritize the survival of all fetuses, even if it means increased risk, while others might prioritize the health of the mother and the long-term well-being of the surviving children. I work to tailor the care plan to align with their preferences, while ensuring their choices are informed and realistic. This often necessitates a multidisciplinary approach, involving ethicists, psychologists, and social workers, to ensure comprehensive support and consideration of all perspectives.

A comprehensive prenatal care plan for multiple pregnancies includes frequent monitoring of both the mother and fetuses. This includes:

• More frequent ultrasound scans: To monitor fetal growth, development, and placental function.
• Regular blood pressure monitoring: To detect and manage gestational hypertension and preeclampsia, which are significantly more common in multiple pregnancies.
• Monitoring fetal heart rates: To assess fetal well-being.
• Assessment for fetal growth restriction: Identifying any significant differences in fetal size (discordant growth).
• Nutritional counseling: To ensure adequate maternal nutrition for healthy fetal development.
• Early delivery planning: Determining the optimal time for delivery, considering fetal maturity and potential risks associated with prolonged gestation.
• Preparation for potential complications: Discussing and preparing for the possibility of premature labor, preeclampsia, placental abruption, postpartum hemorrhage, and other complications common in multiple pregnancies.

Furthermore, the plan needs to address potential psychological and emotional needs of the parents. Regular check-ins, support groups, and access to mental health services are crucial components of holistic care.

I maintain a close understanding of current research and guidelines from organizations like the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM). These organizations publish regular updates on best practices for managing multiple gestations, including recommendations on screening, monitoring, and management of potential complications. I actively participate in continuing medical education programs focused on multiple pregnancy management, attending conferences and workshops to stay abreast of the latest advancements in research and technology.

For example, I’m intimately familiar with the ongoing research on the optimal timing and mode of delivery for various types of multiple pregnancies, as well as advancements in fetal surveillance techniques that improve the detection of fetal distress and growth abnormalities.

Staying current with the latest advancements in multiple pregnancy care involves a multifaceted approach. I actively participate in professional organizations like ACOG and SMFM, subscribing to their journals and attending their conferences. I also review relevant peer-reviewed medical literature regularly. Furthermore, I participate in continuing medical education (CME) courses specifically designed to update my skills in multiple gestation management. Maintaining professional networks with other specialists in the field through collaborative discussions and case reviews is also crucial in enhancing my knowledge and practice.

Discordant fetal growth, where one twin is significantly smaller than the other, is a serious complication requiring close monitoring and potentially intervention. My approach involves meticulous assessment of the size discrepancy using ultrasound measurements and serial growth curves. I would conduct Doppler studies to assess placental blood flow to both fetuses, helping to identify potential causes like placental insufficiency or twin-to-twin transfusion syndrome (TTTS).

Depending on the severity of the discordance and the gestational age, management options range from close observation and frequent monitoring to more aggressive interventions, which may include laser surgery for TTTS or early delivery. The decision to intervene is made on a case-by-case basis, considering the severity of the discordance, gestational age, and the overall health of both the mother and fetuses. Close collaboration with a neonatologist is essential to ensure optimal care for the newborns if early delivery is necessary.