Morbidity associated with prenatal disruption of the dividing membrane in twin gestations

Article Abstract:

Although twins account for about 1 percent of all pregnancies, they account for more than 10 percent of all deaths in the period just before to just after birth, primarily due to prematurity. Monozygotic (one-egg) twins have three times the complication and death rates of dizygotic (two-egg) twins. Monoamniotic twins (those that share the same amniotic sac) have a perinatal death rate that may be as high as 70 percent, according to some studies. This is largely the result of cord entanglement; even when only one twin is affected, the other may succumb or become ill because of factors released from the dead twin. Case reports are presented from eight twin pregnancies in which the amniotic membrane separating the twins ruptured; in seven cases, one placenta was present, and in one case, two placentas were present. In seven cases, the membrane separating the two fetuses ruptured, resulting in both twins' continued maturation within one amniotic cavity. In the eighth case, one amniotic sac of dizygotic twins ruptured, entrapping a finger and foot of one twin. Mortality for the group as a whole was 44 percent, with 7 deaths. The cause of intrauterine amniotic rupture was known in only one case, where it was the result of efforts using laser surgery to correct twin-to-twin transfusion syndrome (in which blood becomes shunted to one twin at the expense of the other). This case, however, had a favorable outcome. A discussion is presented of the possible consequences of membrane rupture. Twin pregnancies characterized by amniotic membranes that appear thin on ultrasound should be watched carefully. Physicians conducting amniocentesis on twin gestations should try to avoid the dividing membrane. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Complications and side effects, Amniotic sac, Amnion

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Monoamniotic twins: a retrospective controlled study

Article Abstract:

During pregnancy, the fetus grows and develops inside of a membrane known as the amniotic sac that is filled with fluid. When a pregnancy results in twins, each fetus usually develops inside of its own amniotic sac (diamniotic twins). However, in a rare condition, both fetuses develop inside one amniotic sac; these are known as monoamniotic twins. This condition occurs in roughly 1 percent of all twin pregnancies and causes death of a fetus in 40 to 60 percent of the cases. This high mortality occurs because the two umbilical cords often become tangled, which cuts off the maternal blood and nutrient supply to one or both of the fetuses. In the past, monoamniotic twins were not diagnosed until birth, but today, ultrasound can be used to reveal this condition. Preterm or early delivery by cesarean section at week 32 of pregnancy has been recommended to reduce the chance of complications. A retrospective study was conducted to compare the complications and outcomes of 20 monoamniotic twin pregnancies with those of 40 normal (diamniotic) twin pregnancies. The monoamniotic twins were more likely to be delivered early, die before birth and have a lower birth weight than the normal twins. However, when the live births from both groups were compared, there were no differences in birth weight or gestational age at the time of birth. All of the fetal deaths occurred before week 32 of pregnancy, indicating that early delivery (at week 32) may not be necessary in all cases. Labor and vaginal delivery, when compared with cesarean section, did not increase the risk of fetal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Risk factors, Pregnancy, Complications of, Pregnancy complications, Fetal death

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