Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

Abstract

The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies. Material and Methods:Retrospective study of all twins born in a tertiary center from January 2004 to December 2013. Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05). Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers. Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

Achados Ultrassonográficos E Desfechos Das Gestações Gemelares Em Uma Maternidade De Referência Em Alto Risco

“…As gestações DC/DA são as mais frequentes e correspondem a 75% dos casos de gemelaridade (ABUHAMAD,2014;ELITO JÚNIOR et al 2018;HERNANDEZ;MIYADAHIRA, 2015;MACHADO et al, 2017;SANTANA et al, 2018A). Em nossa pesquisa as DC/DA também foram as mais encontradas, o que vai ao encontro do encontrado nas literaturas.…”

“…diagnóstico precoce da corionicidade é de fundamental importância para o seguimento pré-natal e para o prognóstico, visto que as GMC estão relacionadas a complicações fetais graves e que necessitam de condutas específicas(DE OLIVEIRA e ELITO JÚNIOR, 2014). As complicações maternas são similares nas GDC e GMC, porém nestas últimas está mais relacionada à morbidade neonatal, com menor idade gestacional e peso ao nascer, além da mortalidade perinatal mais elevada(MACHADO et al, 2017). mais relacionadas a prematuridade, baixo peso ao nascer e partos cesarianos do que as gestações únicas.…”

Assessing an impact on perinatal outcome in monochorionic and dichorionic twin pregnancy complicated with discordant fetal growth

“…ной массы плодов при монохориальной беременности (13,4 %) превосходила таковую при дихориальной (5,4 %). В ретроспективном исследовании 540 беременностей двойней, проведенном М. Machado с соавт., установлено, что при монохориальной двойне чаще встречалась задержка роста одного плода и более низкая масса при рождении [7].…”

“…В нашем исследовании изучение антенатального периода не выявило значимых различий между группами по частоте гестационного диабета и преэклампсии. М. Machado с соавт., проанализировав течение 1051 беременностей двойней, не выявили корреляции между типом хориальности, дискордантным ростом плодов и развитием преэклампсии [7].…”

“…М. Machado с соавт. установили, что частота развития неонатальных осложнений, таких как инфекционно-воспалительные, неврологические и дыхательные нарушения, выше у монохориальной двойни [7]. К.Е.…”