Unequal Placental Sharing

There are no treatments for unequal placental sharing, because the amount of placental share for each twin cannot be changed. Amnioreduction and laser treatment are not beneficial, and could even make things worse, as the underlying problem is not transfusion between the twins.

Instead, the smaller twin is monitored very carefully for signs of difficulty. Depending on the stage of the pregnancy, this may lead to hospitalization for closer monitoring or delivery. It is very important to keep close watch on the smaller twin — if the smaller twin is stillborn, it can possibly cause serious problems for the surviving twin, due to the vascular connections between them.

In severe, early cases of unequal sharing, in which the smaller twin is severely growth restricted and at significant risk of dying before reaching a viable gestational age, radio-frequency ablation (RFA) of umbilical cord flow to that twin may be an option, in order to protect the normally grown twin from the possible adverse effects of the other twin's stillbirth.

UCSF closely monitors patients with unequal placental sharing using a combination of ultrasound and non-stress tests up to three times a week, and in some cases, continuous monitoring in the hospital. In this way, we maximize the benefits of longer gestation and maturity of the fetuses, while maintaining close surveillance of the smaller twin for signs that delivery is necessary.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Intensive Care Nursery
1975 Fourth St., Third Floor
San Francisco, CA 94158
Phone: (415) 353-1565
Fax: (415) 353-1202

Fetal Treatment Center
1855 Fourth St., Second Floor, Room A-2432
San Francisco, CA 94158
Phone: (800) 793-3887
Fax: (415) 502-0660
Appointment information