Monochorionic twins - discordances and risk management

L. Pleș, R.M. Sima, A.D. Stănescu

Rezumat: Twin pregnancy has an increased risk for any pregnancy complication except macrosomia and postterm pregnancy. The incidence of multiple pregnancies has increased in recent years due to assisted reproductive techniques. The main complications of monochorionic pregnancy is the spontaneous reduction of twin pregnancy to single fetus pregnancy in the first weeks of gestation, congenital anomalies or intrauterine growth restriction. TTSS (Twin-to-Twin Transfusion Syndrome) may occure as a complication of the monochorionic pregnancy, being a cause of increased neonatal morbidity and mortality. TTSS is described in approximately 10-15% of monochorionic pregnancies. Another rare specific complication of monochorionic pregnancy is TRAP (twin reversed arterial perfusion sequence) where the body of a fetus with a heart perfuses the other underdeveloped twin. Umbilical cord abnormalities are more common in twin pregnancy and can lead to impaired fetal neurological system. Selective intrauterine growth restricion may be identified in monochorionic twin but this represents the subject of few studies. There are no randomized studies that may indicate an optimum moment of delivery related to placenation. Monochorionic placentation does not indicate the Caesarean section. The decision for mode of delivery is identhic for monoamniothic and biamniothic pregnancy and depends on fetuses position. For uncomplicated monochorionic pregnancy the delivery is generally trought Caesarean section. Monochorionic twin pregnancy is a clinical entity among multiple pregnancies because of its complications, with important implications in neonatal morbidity and mortality.
Cuvinte cheie: twin pregnancy, complications, monochorionic pregnancy.