Artículo de revista
Placental characteristics of monochorionic diamniotic twin pregnancies in relation to early perinatal outcome
Fecha
2011Autor
Rojas, José Luis
Acuña, Edgar Mariano
Molina, Saulo
Franco, Alejandro
Alfonso, Diana
Santana, Nelly
Resumen
Objectives: To evaluate placental characteristics in relation to
perinatal outcome in pairs of monochorionic diamniotic (MCDA)
twins in relation to early perinatal outcome.Methods: Between July 2009 and February 2011, 54 pairs of MCDA
twins and 2 triplets were delivered in 3 tertiary care centers. All
pregnancies were followed with a weekly fetal surveillance for
fetal weight discordance and twin-to-twin transfusion syndrome
(TTTS). After birth, placentas were observed and stained to
search type and number of vascular anastomoses, type and
distance between cord insertions and placental distribution. Birth
weights as fetal and neonatal mortality and early morbidity
were recorded from clinic charts. Placental characteristics were
analized in relation to perinatal outcome. Triplets were analized
separately.
Results: Anastomoses were detected in all placentas with fetal
growth alterations in 44% of the studied pregnancies. Between
fetuses with growth disturbances 12 pairs were diagnosed as TTTS,
9 pairs as selective intrauterine growth restriction (IUGR) and 3
pairs as growth discordances without IUGR. Eight fetal deaths
were recorded, in 2 pregnancies a single fetal death occurred
and in other 3 pregnancies both fetuses died in spite of fetal
therapy. Relation between abnormal cord insertions and smaller
placental territories were seen in all abnormal growth pregnancies
and in 50% of pregnancies without growth disturbances. Between
discordant growth pregnancies, only all TTTS cases had unequal
shared territories and neonatal weight discordance more than
20%. There were 3 cases of severe early morbidity and 6 babies
died during the early neonatal period, most in relation to mayor
malformations.
Conclusions: Placental characteristics are closely related to perinatal
outcome, mainly with the presence of TTTS and fetal growth
disturbances. Prenatal identification of these characteristics in this
group of pregnancies may change parent counselling as surveillance
and intrauterine therapy program.