Specific placental complications of monochorionic diamniotic twins born after 24 weeks of pregnancies – restrospective analysis

Czech version

Authors: I. Vlašínová; L. Hruban; P. Janků; R. Gerychová; P. Ventruba; V. Ťápalová; Z. Hodická
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno, přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in: Ceska Gynekol 2015; 80(3): 189-195

Overview

Objective:
Purpose of this study was to determine the frequency of occurence of specific complications of monochorionic diamniotic twins born after 24 weeks of pregnancies and the effect of these complications on perinatal morbidity and mortality.

Type of study:
Restrospective analysis.

Setting:
Dpt. of Obstetrics and Gynecology Masaryk University and University Hospital Brno.

Methodology:
A retrospective analysis of 175 monochorionic diamniotic pregnancies (mo-bi), which were terminated after the 24th week of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno between the years 2008–2013. The specific complications such as twin-to-twin syndrome (TTTs), twin anemia polycytemia sequens (TAPS), selective intrauterine growth restriction (sIUGR), twin-arterial revers perfusion sequence (TRAP), single intrauterine fetal death (IUFD), placental insufficiency with both twins were identified using prenatal ultrasound examinations, perinatal results and the result of pathological anatomical examinations. Perinatal morbidity, neonatal mortality and neurological development were evaluated. The numbers of late detections of specific complications were observed.

Results:
Specific complications in our group were identified in 50 pregnancies (28.6%). TTTs was diagnosed most often, by 18 pregnancies (10.3%), next most frequent diagnosis were sIUGR (9.7%) and TAPS (3.4%). The placental insufficiency with both twins complicated 2.6% pregnancies. 10 children had abnormal neurological development. Pregnancies with late detection had the worst perinatal results. No acute TTTs during delivery was detected.

Conclusion:
Specific placental complication reached 29.7% in our file. The most frequent complication was TTTs (10.3%) and selective growth restriction (9.7%). Pregnancies with late diagnosis of these complications had the worst results. The prenatal care by monochorial biamnial pregnancies should be at specialized centres from the 16th week of pregnancy every two weeks.

Keywords:
monochorionic diamniotic twins, twin-to-twin syndrome, twin anemia polycytemia sequence, twin-arterial revers perfusion sequence, selective intrauterine growt restrictions

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