Grzesiak Mariusz, Hincz Piotr, Bielak Adam, Gulczyńska Ewa, Wilczyński Jan
Klinika Medycyny Matczyno-Płodowej i Ginekologii Instytutu Centrum Zdrowia Matki Polki.
Ginekol Pol. 2006 Sep;77(9):720-5.
Monoamniotic twins are at most increased risk of perinatal complications with perinatal mortality of 28-60 % reported in literature. The most specific complication to monoamniotic twins is entanglement and (or) knotting of the cords leading to intrauterine death of both (more often) or one twin. In first presented case 1, 23-year-old primigravida in 33wks of twin monoamniotic gestation was reffered to our Institute due to intrauterine death of one co-twin caused by umbilical cord entanglement. In second case, 26-year-old multigravida in monoamniotic twin gestation was admitted to our institution. A serious umbilical cord entanglement was observed and a presence of true knot of umbilical cord was suspected. Presented cases indicate that establishing a chorionicity and amniocity in twin pregnancy is an essential part of ultrasound examination. The diagnosis of cord entanglement in monoamniotic twin pregnancy enables a forecasting of possible complications. According to the established diagnosis future protocols of perinatal management could be proposed. Due to possible complications counseling and management of monoamniotic twins should be performed in tertiary medical centers.
单羊膜囊双胎的围产期并发症风险最高，文献报道其围产儿死亡率为28%-60%。单羊膜囊双胎最特殊的并发症是脐带缠绕和（或）打结，可导致两个胎儿（更常见）或其中一个胎儿宫内死亡。在首例病例中，一名23岁的初产妇，孕33周，单羊膜囊双胎妊娠，因脐带缠绕导致其中一个胎儿宫内死亡，被转诊至我院。在第二例病例中，一名26岁的经产妇，单羊膜囊双胎妊娠，入住我院。观察到严重的脐带缠绕，并怀疑存在脐带真结。上述病例表明，确定双胎妊娠的绒毛膜性和羊膜性是超声检查的重要部分。单羊膜囊双胎妊娠中脐带缠绕的诊断有助于预测可能出现的并发症。根据既定诊断，可提出未来的围产期管理方案。由于可能出现并发症，单羊膜囊双胎的咨询和管理应在三级医疗中心进行。
