Prenatal Outcomes of Monochorionic Pregnancies: Complications, Management and Morbility

Objective: The objetive in this study was to evaluate the incidence and complications of monochorionic twin. Material and Methods: A retrospective study of 32 pregnancies twins monochorionic, a total of 8000 births, controlled Unit Prenatal Diagnosis and Obstetric Area Hospital Juan Ramon Jimenez, where chorionicity was found based on the sonographic features standard and all with the same team ultrasonographic (Voluson 730 Expert). We analyzed fetal complications during pregnancy: Those that have required invasive treatment and hospitalization as well as termination of pregnancy. Patients requiring laser treatment or other management technique fetoscopic were referred to the Hospital Virgen de las Nieves in Granada. The statistical analysis of the variables was performed using the chi-square test for qualitative variables, defining the statistical significance for p <0.01 value. Results: The incidence of monochorionic twin pregnancies in the analyzed period was 21.3% of twin gestations. Maternal age 17-36 was between years, with an average of 28.97. 35.5% of monochorionic twin pregnancies presented complications. No cases of anemia-polycythemia sequence (SAP) was observed and only one presented jarring malformation (no skull). The syndrome fetal-fetal transfusion (TTTS) was diagnosed in 16.1% of cases, performing laser coagulation of placental anastomoses in all of them and selective feticide and subsequent invasive procedure in severe CIR at week 22. In our population 3 cases of ntrauterine growth restriction selective (RCIUs) (9.7%) were observed. The overall rate of prematurity was 64.5%, and 100% for complicated monochorionic gestations. The overall survival rate was 83.9%, and 54.5% for complicated monochorionic gestations. Comparing the survival rate and the overall rate of preterm birth, with the complicated pregnancies a statistically significant difference (p <0.01) was found with a contingency coefficient of 0.5. Conclusions: The incidence of complications in our sample is close to that described in the literature, despite attend a different demographics. The monochorionic twin pregnancy is a type of high-risk twin pregnancy, fetal associated with more complications, which we have observed that predict a high rate of morbidity and mortality. Early diagnosis and proper treatment of the same determine the evolution.