| BackgroundMonochorionic monoamniotic(MCMA)twin pregnancies are rare,but early diagnosis of such pregnancies is critical,as the incidence of complications in these pregnancies is much higher than in diamniotic or dichorionic twin pregnancies.Early diagnosis,close monitoring,timely termination of pregnancy can improve pregnancy outcomes.At present,there are few studies on MCMA twin pregnancies all over the world,and there are still disputes on the epidemiology,diagnostic timing and criteria,fetal complications management and perinatal health strategies of MCMA twin pregnancies,and no expert consensus has been reached.This study intends to retrospectively analyze the clinical data of pregnant women with MCMA twin pregnancies admitted to our hospital,in order to investigate the fetal complications and pregnancy outcomes of MCMA twins,and to explore the perinatal management strategy of MCMA twins,so as to provide some reference for clinicians to formulate the management strategy of MCMA twin pregnancy and improve the pregnancy outcomes.Objective:The purpose of this study is to investigate the fetal complications and pregnancy outcomes of MCMA twins,and to explore the perinatal management strategy of MCMA twins,so as to provide some reference for clinicians to formulate the management strategy of MCMA twin pregnancy and improve the pregnancy outcomes.Method:A retrospective case study was conducted.The subjects of this study were: from October 1,2017 to March 1,2023,a total of 37,451 pregnant women who terminated their pregnancies in the Third Affiliated Hospital of Guangzhou Medical University(our hospital),and a total of 31 twin pregnancies complicated with MCMA who underwent prenatal examination in our hospital or were referred to our hospital from other hospitals.The clinical information of the 31 patients,including basic demographic data,prenatal diagnosis results,perinatal monitoring and pregnancy outcome,was collected and analyzed retrospectively.Research analysis:(1)Pregnancy outcomes of the 31 MCMA twins were systematically analyzed.(2)Grouping comparative study: According to the number of live births of twins,they were divided into three groups: no fetal loss group,one fetal loss group,and two fetal loss group.According to the fetal complications were divided into four groups: Fetal abnormal structure group(group A)and non-abnormal structure group,TRAPS group(group B)and non-traps group,SIUGR group(group C)and non-siugr group,Umbilical cord entanglement group(group D)and non-umbilical cord entanglement group.Result:1.The incidence of monochorionic monoamniotic twin pregnancy in our hospital was0.08%(31/37451).87.1%(27/31)of the pregnancies were natural conception,12.9%(4/31)were in vitro fertilization-embryo transfer.2.Diagnosis of MCMA twin gestation time: All pregnancies were diagnosed at 8 to16+5 weeks gestation.67.7%(21/31)were diagnosed at 11 to 14 weeks of gestation.3.Maternal complications were high,mainly endocrine and metabolic disorders,accounting for 32.3%(10/31),and subclinical hyperthyroidism and gestational diabetes accounted for 16.1%(5/31).4.The main fetal complications were umbilical cord entanglement and structural abnormalities,and the proportions of umbilical cord entanglement,structural abnormalities,SIUGR and TRAPS were 45.2%(14/31),32.3%(10/31),19.4%(6/31)and9.7%(3/31),respectively.5.Compared with the non-SIUGR group,there was a statistically significant difference in the timing of admission(P=0.0015).Compared with the non-umbilical cord group,the diagnosis time of MCMA twin pregnancy(P=0.0227)and gestational week of termination of pregnancy(P=0.0141)were statistically significant.6.Fetal prognosis: Timing of termination of pregnancy in MCMA twins,32.3%(10/31)of MCMA twins terminated pregnancy at 26-32 weeks,and 25.8%(8/31)of MCMA twins terminated pregnancy before 24 weeks.There were 15 cases of live birth of both twins and 16 cases of fetal loss,including 12 cases of both twins and 4 cases of one fetus.The fetal loss rate was 45.2%(28/62).64.3%(18/28),14.3%(4/28),17.9%(5/28)and 3.6%(1/28)of fetal deaths occurred before24,24-28,28-31 and 31 weeks of gestation,respectively.The rates of fetal death from fetal structural abnormalities,TRAPS,SIUGR,and umbilical cord entanglement were 80%(8/10),100%(3/3),66.7%(4/6),and 21.4%(3/14).Fetal structural abnormality(P= 0.0423)and umbilical cord entangling(P=0.002)affected the number of fetal deaths.Conclusion:1.MCMA twins are rare.The incidence in our hospital was 0.08%.It is more common in natural conception and diagnosed at 11-14 weeks of gestation.The most common fetal complications were umbilical cord entanglement and fetal structural abnormalities.2.The rate of fetal loss in MCMA twin pregnancies was high(45.2%),and 64.3%(18/28)of them occurred before 24 weeks of pregnancy.The main risk factors for the loss of both twins were fetal structural abnormality 58.3%(7/12),selective fetal growth restriction 50.0%(2/4)and umbilical cord entangling 50.0%(2/4).The number of fetal deaths caused by fetal structural abnormalities was higher(P=0.0423,OR=7.1),and the number of fetal deaths was lower in the umbilical cord entangling group(P=0.002,OR=0.07).3.Fetal complications and mortality of MCMA twin pregnancy are high,so early diagnosis,standardized perinatal management and close monitoring of timely termination of pregnancy are very important.The frequency of fetal ultrasound monitoring is usually once every two weeks,which is helpful for the detection of fetal complications.According to the maternal and fetal conditions during pregnancy,timely admission to hospital and care and corresponding diagnosis and treatment programs are given to reduce adverse pregnancy outcomes.Prenatal management should focus on ultrasound signs of fetal structural abnormalities,TRAPS,SIUGR,rather than just finding umbilical cord entanglement.For MCMA twin pregnancies,especially after natural reduction or surgical reduction,the gestational age can be extended appropriately with close monitoring and informed consent of the pregnant woman. |
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