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Monochorionic twins

Mert Ozan Bahtiyar, Emre Ekmekci, Emine Demirel, Roxanna A Irani, Joshua A Copel
Monochorionic twin pregnancies are at risk of unique complications due to placental sharing and vascular connections between placental territories assigned for each twin. Twin anemia-polycythemia sequence (TAPS) is an infrequent but potentially dangerous complication of abnormal placental vascular connections. TAPS occurs due to very-small-caliber (< 1 mm) abnormal placental vascular connections which lead to chronic anemia in the donor twin and polycythemia in the recipient twin. TAPS may occur spontaneously or following fetoscopic laser photocoagulation of communicating placental vessels for twin-twin transfusion syndrome...
March 13, 2018: Fetal Diagnosis and Therapy
Erin E Washburn, Teresa N Sparks, Kristen A Gosnell, Larry Rand, Juan M Gonzalez, Vickie A Feldstein
OBJECTIVE:  This article describes the natural history of stage I twin-twin transfusion syndrome (TTTS) including risk of progression to higher stage TTTS and pregnancy outcomes, and to identify risk factors for progression. STUDY DESIGN:  Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS. RESULTS:  A total of 30 MCDA twin pregnancies with expectantly managed stage I TTTS were identified...
February 8, 2018: American Journal of Perinatology
Luiz Felipe Lessa Ortiz, Julio Elito Júnior, Edward Araujo Júnior, Alberto Borges Peixoto, Nelson Sass, Antonio Fernandes Moron
We report the case of a 20-year-old patient, primigravida, with twin monochorionic pregnancy, with a weight gain of 6 kg in one week and increased blood pressure. During the ultrasound diagnostic investigation, placental edema and hydrops were identified in both fetuses, which, in association with maternal anasarca and pressure control, constitute the triad for mirror syndrome, also known as triple edema. In addition to being hydropic, one of the twins was an acardiac fetus, which is a rare combination of events...
2018: Case Reports in Obstetrics and Gynecology
Cristina Mitric, Vincent Ponette
BACKGROUND: In twin pregnancies, elective cerclage placement based on obstetrical history or ultrasound findings has been shown to be ineffective and even harmful. There are currently no guidelines for the use of rescue cervical cerclage in twin pregnancies. CASE: The current report presents the case of a 33-year-old patient with monochorionic diamniotic twins (MCDA) found to have dilated cervix at 3.5cm with exposed membranes upon physical examination at 19 weeks and 3 days...
March 1, 2018: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Ravi Shankar Swamy, Helen McConachie, Jane Ng, Judith Rankin, Murthy Korada, Stephen Sturgiss, Nicholas D Embleton
AIM: Intrauterine growth restriction (IUGR) is associated with poorer outcomes in later life. We used a monochorionic twin model with IUGR in one twin to determine its impact on growth and neurocognitive outcomes. METHODS: Monochorionic twins with ≥20% birth weight discordance born in the north of England were eligible. Cognitive function was assessed using the British Ability Scales. The Strength and Difficulties Questionnaire was used to identify behavioural problems...
March 2, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Nina K Ayala, Linda M Ernst, Emily S Miller
OBJECTIVE: Abnormal umbilical cord coiling is associated with adverse perinatal outcomes; however, the etiology of the umbilical coiling pattern is poorly understood. STUDY DESIGN: Retrospective cohort of all twin deliveries >20 weeks in 2014. Pregnancies were dichotomized by chorionicity and the umbilical coiling index (UCI) and placental cord insertion location were compared. In cases with one or both cords hypercoiled, the direction and pattern of coiling were compared by chorionicity...
February 21, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Rosemary Townsend, Asma Khalil
In the decades since the introduction of ultrasound into routine obstetric practice, the advantages of ultrasound have moved beyond the simple ability to identify multiple pregnancies antenatally to the possibility of screening them for fetal anomalies, pre-eclampsia, preterm birth, and the complications specific to monochorionic pregnancies. Screening studies have often excluded twins because physiological differences impact on the validity and sensitivity of the screening tests in routine use in singletons, and therefore, the evidence of screening performance in multiple pregnancy lags behind the evidence from singleton pregnancies...
February 18, 2018: Seminars in Fetal & Neonatal Medicine
Keisuke Ishii, Seiji Wada, Mayumi Takano, Masahiko Nakata, Takeshi Murakoshi, Haruhiko Sago
INTRODUCTION: We aimed to clarify the survival rate without brain abnormalities (BA) after fetoscopic laser photoco-agulation (FLP) for monochorionic diamniotic twin gestations (MCDA) with selective intrauterine growth restriction (sIUGR) accompanied by abnormal umbilical artery (UA) Doppler waveforms and isolated oligohydramnios in the sIUGR twin. MATERIALS AND METHODS: This retrospective study included 52 cases that underwent FLP. The main outcome was survival rate without BA of the twins at age 28 days...
February 20, 2018: Fetal Diagnosis and Therapy
Jing Lu, Yvonne Kwun Yue Cheng, Yuen Ha Ting, Kwok Ming Law, Tak Yeung Leung
Accurate diagnosis of chorioamnionicity in multiple pregnancies is the key to appropriate clinical management of multiple gestation. Although prenatal ultrasound assessment of chorioamnionicity is well established and highly accurate if performed in early pregnancy, exceptions and artifacts arise from anatomic variations in multiple pregnancies and unusual sonographic features do exist. We have summarized our own experiences and reports from the literature on these pitfalls as follows: (1) Discordant fetal sex in monochorionic pregnancies due to sex chromosome abnormalities, genital malformation in one fetus, or dizygotic twins forming a monochorionic placenta; (2) Separate placental masses in monochorionic pregnancies due to bipartite placenta; (3) False negative and false positive λ sign can arise for various reasons, and in partial monochorionic / dichorionic placentas both T and λ sign may co-exist; (4) Intrauterine synechia appearing as a thick and echogenic intrauterine septum may lead to erroneous diagnosis of dichorionic twins; (5) Errors in ascertaining amnionicity by the visualization of thin inter-twin amniotic membranes and the number of yolk sacs...
February 17, 2018: American Journal of Obstetrics and Gynecology
Yi Zhang, Linhuan Huang, Xuan Huang, Zhiming He, Shaobin Lin, Ye Wang, Lin Li, Yanmin Luo, Qun Fang
OBJECTIVE: To investigate the types of cardiovascular anomalies and the results of invasive prenatal diagnosis in twin fetuses. METHODS: A total of 298 fetuses in 149 twin pairs were enrolled, in which 1 or 2 fetuses of a twin pair had cardiovascular anomalies. Prenatal diagnosis was performed on 290 fetuses of 149 twin pairs, including 150 monochorionic diamniotic (MCDA) fetuses (79 pairs) and 140 dichorionic diamniotic (DCDA) fetuses (70 pairs). G-banding karyotyping and/or chromosomal microarray analysis (CMA) were performed...
February 19, 2018: Prenatal Diagnosis
David Chesler, Richard Bram, Prince Antwi, Andrew T Timberlake, Michael L DiLuna, Kristopher T Kahle
INTRODUCTION: Craniosynostosis is the premature fusion of one or more cranial sutures. The cause of non-syndromic craniosynostosis has been attributed to a complex interaction among genetic, epigenetic, and environmental factors. Increased concordance rates in monozygotic twins support a genetic etiology while a concordance rate less than 100% suggests environmental and/or epigenetic influences. Here, we describe the first reported occurrence of all three children in a triplet set with non-syndromic single-suture craniosynostosis...
February 19, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Takashi Imamura, Hajime Maeda, Hidetoshi Kinoshita, Shogo Kin
When to deliver the monochorionic diamniotic (MCDA) twins with specific cord patterns? Although there is no clear evidence supporting an earlier delivery (before 36 weeks of gestation) in MCDA twins, an earlier delivery might prevent intrauterine death or neuromorbidity in MCDA twins with specific cord patterns.
February 2018: Clinical Case Reports
Haruhiko Sago, Keisuke Ishii, Rika Sugibayashi, Katsusuke Ozawa, Masahiro Sumie, Seiji Wada
The aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin-twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16-26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the 'Solomon technique', induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses...
February 13, 2018: Journal of Obstetrics and Gynaecology Research
Karien E A Hack, Marijn E M S Vereycken, Helen L Torrance, Corine Koopman-Esseboom, Jan B Derks
INTRODUCTIO: The aim of this study was to compare pregnancy outcomes in twin pregnancies after ACand spontaneous conception, according to chorionicity. MATERIAL AND METHODS: Retrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n=731) and assisted conception conceived twin pregnancies (n=574) with antenatal care and delivery in University Medical Center Utrecht, The Netherlands, a tertiary obstetric care center were studied according to chorionicity...
February 11, 2018: Acta Obstetricia et Gynecologica Scandinavica
So Young Kim, Byung Yoon Choi, Eun Young Jung, Hyunsoo Park, Ha-Na Yoo, Kyo Hoon Park
BACKGROUND: We aimed to identify prenatal and postnatal risk factors associated with abnormal newborn hearing screen (NHS) results and subsequently confirmed sensorineural hearing loss (SNHL) in preterm twin neonates. METHODS: Electronic medical records of 159 twin neonates who were born alive after ≤32 weeks were retrospectively reviewed for hearing loss in both ears. Histopathologic examination of the placenta was performed and clinical data, including method of conception and factors specific to twins, were retrieved from a computerized perinatal database...
January 31, 2018: Pediatrics and Neonatology
Maela Le Lous, Imen Mediouni, Gihad Chalouhi, Laurent Salomon, Laurence Bussières, Aude Carrier, Jean-Pierre Bernard, Yves Ville
OBJECTIVES: The objective of our study was to determine the impact of laser therapy for twin-to-twin transfusion syndrome (TTTs) on subsequent pregnancies. METHODS: This was a monocentric retrospective observational study. Women treated by laser fetoscopy for TTTs were asked to answer a postal questionnaire about subsequent pregnancies. The primary outcome was fecundity (number of pregnancies and time to pregnancy). We also assessed pregnancy complications, birth weight, and gestational age at delivery...
February 8, 2018: Prenatal Diagnosis
Hakan Timur, Rifat Taner Aksoy, Aytekin Tokmak, Burcu Timur, Bugra Coskun, Dilek Uygur, Nuri Danisman
OBJECTIVES: Multiple pregnancies are known to be associated with adverse maternal and perinatal complications. How-ever, data regarding the outcomes of spontaneously reduced twin pregnancies are limited. In the current study we aimed to evaluate the consequences of the vanishing twin syndrome (VTS) in dichorionic diamniotic twin pregnancies for both mother and baby in our perinatal center. MATERIAL AND METHODS: A total of 711 pregnancies were included into the study...
2018: Ginekologia Polska
Mònica Druguet, Laura Nuño, Carlota Rodó, Silvia Arévalo, Elena Carreras, Juana Gómez-Benito
OBJECTIVE: To examine the psychological effect on women of the loss of one or both fetuses during a monochorionic twin pregnancy and to identify associated protective and risk factors. DESIGN: Descriptive, cross-sectional, correlational study. SETTING: Maternity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. PARTICIPANTS: Twenty-eight White Spanish women who lost one or both fetuses during a monochorionic twin pregnancy...
January 31, 2018: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
Rishi Philip Mathew, Swati Francis, Ram Shenoy Basti, Hadihally B Suresh, Annie Rajarathnam, Prema D Cunha, Sujaya V Rao
Introduction: Conjoined twins are identical twins with fused bodies, joined in utero. They are rare complications of monochorionic twinning. The purpose of this study is to describe the various types of conjoined twins, the role of imaging and recent advances aiding in their management. Material and methods: This was a twin institutional study involving 3 cases of conjoined twins diagnosed over a period of 6 years from 2010 to 2015. All the 3 cases were identified antenatally by ultrasound...
December 2017: Journal of Ultrasonography
Asma Khalil, Irene Beune, Kurt Hecher, Klaske Wynia, Wessel Ganzevoort, Keith Reed, Liesbeth Lewi, Dick Oepkes, Eduardo Gratacos, Basky Thilaganathan, Sanne J Gordijn
OBJECTIVES: Twin pregnancies complicated by selective fetal growth restriction (sFGR) are associated with increased perinatal mortality and morbidity. Inconsistences in the diagnostic criteria for sFGR employed in existing studies hinder the ability to compare or combine their findings. It is therefore challenging to establish robust evidence-based management or monitoring pathways for these pregnancies. The main aim of this study was to determine, by expert consensus using a Delphi procedure, the key diagnostic features of and the essential reporting parameters in sFGR...
January 24, 2018: Ultrasound in Obstetrics & Gynecology
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