Ultrasound technology has ushered in a transformative era in the effective management of multiple pregnancies and their associated complications. With the rising prevalence of twin pregnancies, it is imperative for clinicians across disciplines to possess comprehensive knowledge of relevant pathologies, as well as familiarity with evidence-based surveillance and management protocols. This review serves as a comprehensive synthesis of the most recent evidence concerning ultrasound surveillance in twin pregnancies. Encompassing critical aspects such as first trimester assessment and screening, growth surveillance, and the identification and management of complications specific to monochorionic pregnancies—including but not limited to twin-to-twin transfusion syndrome, selective fetal growth restriction, twin reversed arterial perfusion sequence, and conjoined twinning—the article aims to empower healthcare professionals with the latest insights for optimal care and outcomes in multiple pregnancies.
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