Management of Monochorionic Monoamniotic Twin Pregnancy Experience of a Tertiary CenterPP

Yıl 2020, , 416 - 419, 25.12.2020

Engin Öztürk , Emre Ekmekci

https://doi.org/10.35440/hutfd.816830

Öz

Background: Evaluation of obstetric outcomes of monochorionic monoamniotic twin pregnancies (MCMA) with our management method that we apply in our clinic, and to describe the complications in these pregnancies.
Materials and Methods: MCMA twin pregnancies that are followed and finalized in our clinic in three years period were included in the study. The data were collected retrospectively, pregnancy outcomes of the pregnancies included in the study, pregnancy complications specific to monochorionicity and congenital malformations in these pregnancies were recorded.
Results: A total of 12 MCMA twin pregnancies were followed and managed in our clinic over a three-year period. In three cases, intrauterine death of co-twin was complicated in prenatal period. In one case, it resulted in intrauterine demise of both fetuses. No monochorionicity-specific complication was encountered in any case. Discordantly congenital malformations were present in both twins in one pregnancy
Conclusion: MCMA pregnancies are rare but one of the most complex and controversial issues in terms of management in perinatal medicine. There is no clarity yet on how to manage and when to deliver. In this study, we reported our experience with our management protocol in our clinic.

Key words: Monochorionisity, Monoamniotic pregnancy, Monozygosity

Monokoryonik Monoamniyotik İkiz Gebeliklerde Tersiyer Bir Merkezdeki Deneyimimiz

Öz

Amaç: Monokoryonik monoamniyotik ikiz gebeliklerin (MKMA) kliniğimizdeki uyguladığımız yönetim şekli ile gebelik sonuçlarının değerlendirilmesi, bu gebeliklerdeki komplikasyonların tanımlanması.
Materyal ve metod: Çalışmaya üç yıllık süreçte kliniğimizde takip edilen ve sonuçlandırılan MKMA ikiz gebelikler dahil edildi. Veriler retrospektif olarak toplandı, çalışmaya dahil edilen gebeliklerin gebelik sonuçları, monokoryonisiteye spesifik gebelik komplikasyonlar ve bu gebeliklerdeki konjenital malformasyonlar kaydedildi.
Bulgular: Üç yıllık süreçte toplam 12 MKMA ikiz gebeliğin kliniğimizde takip ve yönetimi uygulanmıştır. Üç olguda ikiz eşi doğum öncesi dönemde intrauterin fetal kayıp ile komplike olmuştur. Bir olguda her iki fetüsün intrauterin kaybı ile sonuçlanmıştır. Hiçbir olguda monokoryonisite spesifik komplikasyon ile karşılaşılmadı. Bir olguda her ikizde diskordan konjenital malformasyonlar mevcuttu.
Sonuç: MKMA gebelikler nadir fakat perinatal tıpta en karmaşık ve yönetim açısından tartışmalı konulardandır. Nasıl yönetilmesi ve ne zaman teslim edileceği konusunda henüz netlik yoktur. Bu çalışmada kliniğimizdeki yönetim protokolümüzle ilgili deneyimimizi bildirdik.

Anahtar Kelimeler: Monokoryonisite, Monoamniyotik ikiz, Monozigosite

Anahtar Kelimeler

Monokoryonisite, monoamniyotik ikiz, monozigosite

Kaynakça

• Referans1 Black M, Bhattacharya S, editors. Epidemiology of multiple pregnancy and the effect of assisted conception. Seminars in Fetal and Neonatal Medicine; 2010;15(6):306-312.
• Referans2 Shub A, Walker SP. Planned early delivery versus expectant management for monoamniotic twins. Cochrane Database Syst Rev. 2015 Apr 15;4:CD008820. doi: 10.1002/14651858.CD008820.pub2. Review.
• Referans3 Morikawa M, Yamada T, Yamada T, Sato S, Minakami H. Prospective risk of intrauterine fetal death in monoamniotic twin pregnancies. Twin Research and Human Genetics. 2012;15(4):522-6.
• Referans4 Glinianaia SV, Rankin J, Khalil A, Binder J, Waring G, Sturgiss SN, et al. Prevalence, antenatal management and perinatal outcome of monochorionic monoamniotic twin pregnancy: a collaborative multicenter study in England, 2000–2013. Ultrasound in Obstetrics and Gynecology. 2019;53(2):184-92.
• Referans5 Post A, Heyborne K. Managing monoamniotic twin pregnancies. Clinical obstetrics and gynecology. 2015;58(3):643-53.
• Referans6 Mutchinick OM, Luna Muñoz L, Amar E, Bakker MK, Clementi M, Cocchi G, et al., editors. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. American Journal of Medical Genetics Part C: Seminars in Medical Genetics; 2011;157(4):274-287.
• Referans7 Van Mieghem T, De Heus R, Lewi L, Klaritsch P, Kollmann M, Baud D, et al. Prenatal management of monoamniotic twin pregnancies. Obstetrics and Gynecology. 2014;124(3):498-506.
• Referans8 Derom C, Vlietinck R, Derom R, Van den Berghe H, Thıery M. Population-based study on sex proportion in monoamniotic twins. The New England Journal of Medicine. 1988;319(2):119-20.
• Referans9 Hack K, van Gemert M, Lopriore E, Schaap A, Eggink A, Elias S, et al. Placental characteristics of monoamniotic twin pregnancies in relation to perinatal outcome. Placenta. 2009;30(1):62-5.
• Referans10 Aisenbrey GA, Catanzarite VA, Hurley TJ, Spiegel JH, Schrimmer DB, Mendoza A. Monoamniotic and pseudomonoamniotic twins: sonographic diagnosis, detection of cord entanglement, and obstetric management. Obstetrics and Gynecology. 1995;86(2):218-22.
• Referans11 Rossi A, Prefumo F. Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature. Ultrasound in Obstetrics and Gynecology. 2013;41(2):131-5.
• Referans12 D'Antonio F, Odibo A, Berghella V, Khalil A, Hack K, Saccone G, et al. Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and metaanalysis. Ultrasound in Obstetrics and Gynecology. 2019;53(2):166-74.