Monoamniotic twins pregnancy complicated by a fetal congenital heart defect – a challenge for perinatal decisions
-
Monika Pasieczna
,
Joanna Kuran-Ohde
Abstract
Objectives
To analyze pregnancy management and postnatal follow-up in monochorionic monoamniotic (MCMA) pregnancies complicated by a congenital heart defect (CHD) in one twin and to compare the results with current recommendations concerning time and mode of delivery in MCMA pregnancies.
Cases presentation
Perinatal medical records of five pairs of monoamniotic twins referred to Fetal Cardiology Department were analyzed. 5 out of 23 MCMA pregnancies (21.7%) were complicated by CHD in one fetus. Cesarean section (CS) was performed between 32 and 35 weeks of gestation (WoG). 9 out of 10 neonates had respiratory failure, including all patients with CHD. Twins without congenital abnormalities spent median 21 days (range 10–40 days) in neonatal units. Patients with CHD were transferred to cardiology departments on average 6th day of life. All were operated on later than term-born neonates, 4 out of 5 required stage surgery and their median stay in the hospital was 75 days (range 48–106 days).
Conclusions
According to current recommendations, delivery in MCMA pregnancies should be scheduled at 32–34 weeks. In cases complicated by CHD in one twin, such early delivery complicates surgical treatment and may affect the final outcome. Low body weight and respiratory disorders increase the risk of complications in the perioperative period and prolong hospitalization.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The Ethical Committee of the Medical University of Warsaw approved the study.
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© 2020 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Case Reports – Obstetrics
- Fetal pulmonary choristoma: report of first case and literature review
- Ultrasound prenatal diagnosis of a de novo 14q distal duplication associated with foetal anomalies: a case report
- Prenatal diagnosis of Kleefstra syndrome
- Cardiac implant and the risk of infective endocarditis in pregnancy
- Iatrogenic fetal goiter. Conservative management and spontaneous resolution
- Management in cases of large uterine myomas in pregnancy
- Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester
- A case report of co-infection with rhinovirus and SARS-CoV-2 in pregnancy
- Monoamniotic twins pregnancy complicated by a fetal congenital heart defect – a challenge for perinatal decisions
- Favorable outcome after nine minutes of shoulder dystocia preceded by a tight nuchal cord
- Circumvallate placenta and abnormal cord insertion as risk factors for intrauterine growth restriction and preterm birth: a case report
- A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma
- Septated fetal bladder in a case of 2q13 deletion
- A case of prenatal diagnosis of single umbilical artery due to thrombosis diagnosed by the ultrasound finding of “wink-sign”
- Ultrasound diagnosis of myelomeningocele: the role of 3D ultrasonography in determining surficial status of the pathological lesion
- Pragmatic approach and variations in the management of pregnant women with type 1 diabetes mellitus on insulin pump: a case series
- A great pre-eclampsia masquerader. Hemophagocytic lymphohistiocytosis (HLH) presenting in pregnancy
- Survival of both twins in a pregnancy complicated by pre-viable cord prolapse at 21 weeks of gestation
- A case report of a pregnant woman diagnosed with intrahepatic cholangiocarcinoma (ICC) complicated by opioid tolerance
- Prenatal and postnatal imaging of an intrapericardial teratoma
- Case report of a ruptured uterine sacculation in the 19th week of pregnancy
- Is thromboelastography reliable in postpartum coagulopathies? Two case reports and a literature review
- Prenatal diagnosis of megacystis-microcolon-intestinal hypoperistalsis syndrome
- Fetal head entrapment within the lower uterine segment
- Case Reports – Fetus
- A case of diprosopus: a rare form of twinning radiology-pathology correlation
- Case Reports – Newborn
- Transmission of SARS-CoV-2 to premature twins from an asymptomatic mother
- Spinal dysraphism, club feet, and dextrocardia with situs inversus totalis in a neonate: a rare association and review
- Giant congenital vascular malformation: diagnostic approach and clinical course
- Transient neonatal myasthenia gravis following maternal myasthenia gravis presenting in pregnancy after treatment with Alemtuzumab
- Congenital pulmonary lymphangiectasia in an extremely low birth weight: a case report
- Congenital kaposiform hemangioendothelioma: don’t let the appearances fool you
- Agnathia-otocephaly complex: a case report and a literature review on recurrence risk
- Perinatal severe hypophosphatasia: a case report
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- Congenital high airway obstruction syndrome complicated with foregut malformation and high airway fistula to the alimentary tract – a case series with four distinct types
- Aplasia cutis congenita as a consequence of fetal reduction in a triplet pregnancy
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