Monochorionic Twin Pregnancy— Potential Risks and Perinatal Outcomes

Elito, Júlio; Santana, Eduardo Félix Martins; Cecchino, Gustavo Nardini

doi:10.5772/58951

Cited by 6 publications

(3 citation statements)

References 121 publications

(171 reference statements)

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“…6 Regular ultrasound monitoring can help predict pregnancies with an increased risk of fetal growth restriction and growth discordance. 5,15 Observational studies show that once surveillance is implemented, the prospective risk of fetal death decreases by 5% compared to before surveillance was implemented. It is recommended to refer monoamniotic twin pregnancies to specialized centers for management and delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Considering monoamniotic twins, most centers would suggest a cesarean delivery to prevent cord prolapse or accidental clamping of the second twin's cord, which could be securely wrapped around the neck of the first twin. 7,15 A cesarean section is recommended to be done at 32 to 34 weeks of gestation age. 4 To reduce the risk of cord prolapse for the remaining fetus, fetoscopic cord transection of the deceased fetus may be considered on a case-by-case basis.…”

Section: Discussionmentioning

confidence: 99%

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The management of Monochorionic Monoamniotic (MCMA) twin pregnancy

Ernawati,

Qonitatillah,

Sulistyono

2023

MOG

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HIGHLIGHTS Monochorionic monoamniotic (MCMA) twin pregnancy has a significant risk of perinatal morbidity and mortality, including intrauterine fetal death (IUFD). The risk of prematurity, the risk of death due to MCMA complications, the availability of the NICU, also high costs on preterm care were factors in deciding to terminate the pregnancy. The ideal time to deliver monochorionic twins in order to reduce the risks of cord entanglement, growth discrepancies, and intrauterine fetal death is still a point of controversy. Early diagnosis, intensive antenatal monitoring, patient and family decision would contribute to antenatal mortality reduction. ABSTRACT Objectives: To present the management of monochorionic monoamniotic (MCMA) twin pregnancy. Case Report: Advanced prenatal treatment has improved the prognosis for Monochorionic Monoamniotic (MCMA) pregnancies; however, there is still no agreement on how to handle MCMA twins. The authors report 2 cases of monoamniotic monochorionic twin pregnancies. In the first case, a 30-years-old primi pregnant woman detected MCMA at 14 weeks of gestation; no complications related to MCMA were found; she planned delivery at 32 weeks, but one of the babies died in the womb at 31/32 weeks pregnant, a live baby born by cesarean section. The second case was a 36-year-old pregnant woman, on her third pregnancy, diagnosed with MCMA after 12 weeks of pregnancy, no complications related to MCMA, the baby was born at 32 weeks pregnant, and both babies survived. The management was the same in both cases, but different outcomes were obtained; in case 1, the baby died allegedly due to cord entanglement, which could not be detected during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The management of Monochorionic Monoamniotic (MCMA) twin pregnancy

Ernawati,

Qonitatillah,

Sulistyono

2023

MOG

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“…Twin pregnancies, especially monochorionic that are mostly MZ [39], are risky (e.g., adverse effects include twin-twin transfusion syndrome, twin anemia polycythemia sequence, selective intrauterine growth restriction, twin reversed arterial perfusion sequence), calling for increased medical and societal attention (e.g., [48,49]). The chance of maternal mortality associated with multiple pregnancies is higher in comparison with singleton pregnancies.…”

Section: Twinning As An Adapted Propensitymentioning

confidence: 99%

Twinning as an Evolved Age-Dependent Physiological Mechanism: Evidence from Large Brazilian Samples

Varella¹,

Fernandes²,

Arantes³

et al. 2019

Multiple Pregnancy - New Challenges

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Multiple pregnancies occur in humans and other primates, which indicate that the twinning propensity is phylogenetically old. Factors such as decreased sexual dimorphism and size, rich and diverse nutrition and paternal care are related to multiple pregnancies in other animals. In human populations, despite its costs, twinning has a genetic basis and in Europe, Africa, and America, it was found that it increases mothers' fitness. Here, we explore the hypothesis that twinning represents an evolved physiological mechanism, particularly in mothers of higher age, as an 'all-or-nothing' last chance strategy for reproduction just before menopause. We present decade-long, large-scale population data about maternities from the city of São Paulo and the entire country of Brazil that indicate a considerable main effect of advanced age in promoting twinning, particularly dizygotic (DZ) twinning, but also monozygotic (MZ) twinning and higher order maternities. We also show that socioeconomic status is an important contextual factor increasing twinning. Besides the theoretical implications, these datasets establish a Brazilian countrywide twinning rate of 9.39‰ and highlight an increasing historical trend. This chapter promotes the importance of integrating proximate patterns from human and nonhuman animals and evolutionary factors in order to reach a comprehensive view about twinning.

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