A 26-year-old woman with a monochorionic twin pregnancy shows signs of polyhydramnios in one twin and oligohydramnios in another. What is the best clinical intervention?

In cases of monochorionic twin pregnancies where one twin presents with polyhydramnios and the other with oligohydramnios, the best clinical intervention is often expectant management with monitoring. This approach is favored because it allows for close observation of both twins and the progression of the pregnancy, as many complications associated with this type of twin pregnancy can resolve spontaneously over time.

Polyhydramnios in one twin could be indicative of fetal anomalies or overproduction of amniotic fluid, while oligohydramnios in the other twin might suggest underproduction or a placental blood flow issue. Monitoring enables healthcare providers to assess fetal well-being and makes it possible to intervene at a later date if necessary, rather than immediately resorting to more invasive or aggressive interventions.

Indomethacin, which is sometimes used to reduce amniotic fluid volume in cases of polyhydramnios, could have risks associated with it and is not always appropriate for all situations, especially not as a first-line approach. Selective reduction could be considered in certain cases, but it is more commonly indicated for higher-order multiples or if specific fetal anomalies are identified that warrant such an intervention. Cervical cerclage is typically indicated in cases of cervical incompetence and would not