Retrospective analysis of monochorionic twin pregnancies born in the Institute for the Care of Mother and Child between 2012–2015

Česká verzia

Authors: K. Běhávková ¹; L. Krofta ^1,2; K. Macková ¹; J. Vojtěch ¹; L. Hašlík ¹; R. Pock ¹; L. Hympánová ¹; M. Kučerová ¹; H. Heřman ¹; Z. Straňák ^1,2; J. Feyereisl ^1,2,3
Authors place of work: Ústav pro péči o matku a dítě, Praha, ředitel doc. MUDr. J. Feyereisl, CSc. ¹; 3. lékařská fakulta Univerzity Karlovy, Praha ²; Katedra gynekologie a porodnictví IPVZ, Praha ³
Published in the journal: Ceska Gynekol 2017; 82(3): 180-189

Summary

Objective:
The purpose of this study was to describe monochorionic twin pregnancies and their complications, born between 24^th and 37^th week of gestation in the Institute for the Care of Mother and Child in years 2012–2015.

Design:
Retrospective cohort.

Setting:
The Institute for the Care of Mother and Child, Praha.

Methods:
From 2012 to 2015 we observed 177 monochorionic twin pregnancies from which two or one viable fetuses were born, or both fetuses died in utero.

Results:
From a total of 177 women, 12 (6.8%) gave birth before 26th week of gestation, between 26+0 – 27+6 four women (2.3%) gave birth, 37 women (20.9%) between 28+0 – 31+6, 84 women (47.8%) between 32+0 – 35+6 and after 36th week of gestation 40 women (22.6%) gave birth. Mean week of delivery was 33.8.

Indications for termination of pregnancies were premature rupture of membranes (PPROM) in 11.9%, onset of spontaneus uterine contractions in 12.4% and in 53.3% other iatrogenic indication. 23.3% of pregnancies in our cohort were uncomplicated and terminated after 36th week of gestation.

We performed caesarean section in 94.3%, in 5.7% patients gave birth vaginally.

In vitro fertilization had 19.9% women, 80.1% conceived spontaneously.

The age range of pregnant women in our cohort was 20–43, with median 32.3.

Mean weight of bigger fetus was 2047.6 g (min. 520 g, max. 3530 g), mean weight of smaller fetus was 1799.5 g (min. 350 g, max. 2790 g).

In 30 cases (16. 9%) we performed intrauterine intervetion. In 21/30 cases (11.9%) for TTTS diagnose, in 5/30 cases (2.8%) for congenital abnormalities or TRAP sequence and in 4/30 cases (2.2%) for sIUGR type III.

The most frequent complication in our cohort was sIUGR (36 patients – 20.3%), TTTS (21 patients – 11.9%) and on the third place congenital abnormality or TRAP sequence (five patients – 2.8%)

Nineteen patients gave birth to one viable fetus, in two cases both fetuses died in utero. In one case, in twin pair, one new-born died shortly after the birth – it had several congenital abnormalities and due to anhydramnion it was impossible to perform amnioinfusion and umbilical cord occlusion. After the birth it was given palliative care.

Conclusion:
The study brought data about specific risks in monochorionic twin pregnancies and suggests careful observation of women in fixed intervals and necessity of immediate referral to perinatal centre in case of any suspicious or pathological finding.

Keywords:
monochorionic pregnancies, transfusion syndrome, growth restriction

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