Complications of multifetal pregnancies

In the case of multifetal pregnancies, it is extremely important for the gynecologist to determine in the ultrasound examination, in addition to the number of fetuses, the number of chorionic villi and amniotic membranes, or fetal membranes. The number of chorionic villi provides information on the number of placentas, i.e. if the pregnancy is monochorionic, the twins share one placenta, while if it is bicorionic-each baby has its own placenta. The same is true of amniotic sacs, which contain fetuses. If the pregnancy is a two-harbor pregnancy-each baby is in a separate amniotic sac, and when there is a one-harbor pregnancy, the fetuses are surrounded by a single sac.

With this knowledge in the following weeks of pregnancy, the specialist will carry out appropriate monitoring of the development of children. In the event of complications, which most often occur in the course of singleton pregnancies, he will refer the pregnant woman to a center specializing in  conditions, such as fetal-to-fetal transfusion syndrome or selective fetal growth restriction. Highly specialized centers have the best doctors and methods capable of reducing the consequences of the aforementioned complications and providing care to the mother-to-be and children in accordance with the highest international standards.

TTTS-what is it?

Transfusion syndrome between fetuses (TTTS- Twin To Twin Transfusion Syndrome) is a complication specific to singleton pregnancies. It occurs due to the occurrence in the common placenta of anastomoses, i.e. connections of blood vessels between fetuses. Because of this, there are situations where one of the children becomes a blood donor and the other a recipient, and because of this they develop abnormally. This is because the donor develops growth restriction, anemia and thrombocytopenia. In turn, the recipient develops polycythemia vera, circulatory failure and, consequently, generalized edema.

• TTTS-treatment

Untreated fetal-to-fetal transfusion syndrome is believed to be 80-100% fatal for babies. However, effective treatment for TTTS is now available in the form of fetoscopic (without opening the uterine cavity) occlusion (closure) of anastomoses. This treatment involves laser photocoagulation of blood vessel connections. This separates the circulation of the two fetuses, allowing them to develop properly. According to the study, the survival rate of one child after the procedure is about 85%, and that of two is 65%.

TRAP

Twin Reversed Arterial Perfusion (TRAP) syndrome affects about 1% of singleton pregnancies. This is a situation in which a healthy fetus and a second fetus without a heart(acardiacus) develop. Because of this, a healthy baby has to pump blood for both of them, putting them at risk of complications such as circulatory failure, generalized edema, and ultimately death. Treatment of reverse arterial perfusion syndrome involves separating the acardiacus circulation from the healthy fetus. Similar to the treatment of TTTS, a thin needle is inserted into the uterine cavity and the vessels are closed by laser or the umbilical cord of the affected fetus is ligated. This enables healthy children to develop properly.

TAPS

Anemia-Polycythemia Sequence (TAPS- Twin Anemia-Polycythemia Sequence)  is a complication of about 5% of singleton pregnancies. As a result of chronic blood flow between fetuses, significant differences in hemoglobin concentration occur. TAPS is found by an increase in the maximum systolic flow velocity in the middle cerebral artery on Doppler ultrasound in one of the children, indicating anemia (anemia). In the other, on the other hand, there is edema and polycythemia (hyperemia). Management is based on laser photocoagulation, intrauterine intrauterine transfusions or, in due course, early termination of pregnancy.

sIUGR

Selective intrauterine growth restriction (sIUGR- selective intrauterine growth restriction) is associated with uneven development of twins and the difference between their estimated body weights. This complication affects multiple pregnancies, both monozygotic and bzygotic. It can result, among other things. From unequal sharing of the common placenta between the children (in singleton pregnancies). The diagnosis of sIUGR requires accurate and frequent ultrasound evaluations of child development, and it is often necessary to terminate the pregnancy prematurely.

Twins incompletely separated

Incomplete-separated twins are formed as a result of too late division of the zygote, i.e. after 12 days after fertilization. It affects 70% of female fetuses. About 60% of incompletely separated twins die intrauterine deaths, and only 35% of those born alive survive the first 24 hours. Most often, children are connected through the thoracic (Thoracopagus) and epigastric (Xiphopagus). These twins are referred to as Siamese. It is named after brothers Chang and Enga Bunker, who were born in 1811 in Siam and were united among others. bridges. Modern medicine makes it possible to operate on the separation of children after birth, depending on the degree of their fusion.