2017, Number 02
Ginecol Obstet Mex 2017; 85 (02)
Molina-Giraldo S, Solano-Montero AF, Santana-Corredor NL, Ortega C, Alfonso-Ayala DA
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ABSTRACTObjetive: To evaluate placental characteristics in monochorionic multiple pregnancies in relation to obstetric outcome in our environment.
Material and Method: Prospective and observational study was made; carried to 31 July 2009 and 31 August 2011 in two high complexity institutions in Bogota, Colombia. We included monochorionic pregnancies for diagnosis of complications, management and perinatal outcome, placental analyzes were evaluated with respect to the number and type of anastomosis, type and distance between umbilical cord insertions and placental sharing.
Results: We registrered 72 monochorionic pregnancies, twin pregnancies were 93.1% and 86.1% diamniotic. Placentas analyzed 91.6% had at least one placental anastomosis, arterio-arterial mainly in 70.8% of patients. Complications of monochorionic pregnancies in 41.6% of cases mainly selective growth restriction in 16 cases, followed by twin to twin transfusion in 11 pairs of twins were found. A case of blood transfusion reverse was presented; and a fetal mortality of 10.7% remains the leading cause twin to twin transfusion syndrome. Among the causes of neonatal morbidity transient tachypnea of the newborn, followed by hyaline membrane disease were found. The neonatal mortality rate was 5.4%. There were no maternal deaths.
Conclusion: Placental characteristics determine the complications of monochorionic pregnancy, as the presence of twin to twin transfusion syndrome selective growth restriction and perinatal outcome. Prenatal sonographic identification of these features is important for prenatal counseling and the frequency of gestational surveillance.