2010, Number 03
PDF size: 351.06 Kb.
ABSTRACTBackground: Monochorionic biamniotic (MC/BA) twin pregnancies are at higher risk for twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR) and structural defects.
Material and method: During an 18 months period all MC/BA twins referred to our unit for clinical surveillance were evaluated. Chorionicity was assessed based on the characteristics of the intertwin amniotic membrane. MC complicated cases were labeled either as, TTTS or sIUGR and classified according to severity. All cases were closely evaluated for structural defects.
Results: There were 34 MC/BA pregnancies, from them 20 presented TTTS, 6 in a moderate stage of severity, and 14 severely affected. Four cases had sIUGR, all severely affected. Four pregnancies showed a structural defect, 2 cardiac, 1 urological, and 1 open neural tube defect. Six twin MC/BA pregnancies underwent gestation without complications.
Conclusion: The presence of a MC/BA twin pregnancy warrants close monitoring, including a detailed anatomical review and hemodynamic assessment of the umbilical arteries and ductus venosus of both twins.
Lewi L, Van Schoubroeck D, Gratacós E, et al. Monochorionic diamniotic twins: complications and management options. Curr Opin Obstet Gynecol 2003;15:177-194.
Gaziano E, De Lia J, Kuhlmann R. Diamnionic monochorionic twin gestations: an overview. J Matern Fetal Med 2000;9:89-96.
Wee LY, Sullivan M, Humphries K, Fisk NM. Longitudinal blood flow in shared (arteriovenous anastomoses) and nonshared cotyledons in monochorionic placentae. Placenta 2007;28:516-522.
Sebire NJ, Snijders RJ, Hughes K, et al. The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynaecol 1997;104:1203-1207.
Dube J, Dodds L, Armson BA. Does chorionicity or zygosity predict adverse perinatal outcomes in twins? Am J Obstet Gynecol 2002;186:579-583.
Adegbite AL, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight. Am J Obstet Gynecol 2004;190:156-163.
Sepulveda W, Sebire NJ, Hughes K, et al. The lambda sign at 10-14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol 1996;7:421-423.
Gratacos E, Deprest J. Current experience with fetoscopy and the Eurofoetus registry for fetoscopic procedures. Eur J Obstet Gynecol Repr Biol 2000;92:151-159.
Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinato 1999;19:550-555.
Gratacós E, Lewi L, Muñoz B, et al. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 2007;30:28-34.
Umur A, van Gemert M, Nikkels P. Monoamniotic-versus diamniotic-monochorionic twin placentas: Anastomoses and twin-twin transfusion syndrome. Am J Obstet Gynecol 2003;189:1325-1329.
Mahony BS, Petty CN, Nyberg DA, Luthy DA, et al. The “stuck twin” phenomenon: ultrasonographic findings, pregnancy outcome, and management with serial amniocenteses. Am J Obstet Gynecol 1990;163:1513-1522.
Seng YC, Rajadurai VS. Twin-twin transfusion syndrome: a five years review. Arch Dis Child Fetal Neonatal 2000;83:F168-170.
Cincotta RB, Gray PH, Phythian G, et al. Long term outcome of twin-twin transfusion syndrome. Arch Dis Child Fetal Neonatal 2000;83:171-176.
Lewi L, Cannie M, Blickstein I, et al. Placental sharing, birth weight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas. Am J Obstet Gynecol 2007;197:587.e1-8.
Driggers RW, Blakemore KJ, Bird C, et al. Pathogenesis of a cardiac twinning: clues from an almost a cardiac twin. Fetal Diagn Ther 2002;17:185-187.
Sperling L, Kiil C, Larsen LU, et al. Detection of chromosomal abnormalities, congenital abnormalities and transfusion syndrome in twins. Ultrasound Obstet Gynecol 2007;29:517-526.
Edwards M, Elling J, Newman R, Menard M. Predictive value of antepartum ultrasound examination for anomalies in twin gestations. Ultrasound Obstet Gynecol 1995;6:43-49.
Bryan E, Little J, Burn J. Congenital anomalies in twins. Baillieres Clin Obstet Gynecol 1987;1:697-721.
Valenzuela MP, Becker VJ, Carvajal JC. Pautas de manejo clínico de embarazos gemelares. Rev Chil Obstet Ginecol 2009;74:52-68.
Duncombe GJ, Dickinson JE, Evans SF. Perinatal characteristics and outcomes of pregnancies complicated by twin-twin transfusion syndrome. Obstet Gynecol 2003;101:1190-1196.
Gratacós E. Gestación múltiple: aspectos generales y relevância em Medicina Fetal. En: Gratacós E, Romero R, Cabero L, Gómez R, Nicolaides KH, editores. Medicina fetal. 1a ed. Madrid: Panamericana, 2007;p:687-694.