Embarazo Gemelar Monocorial Biamniotico en el segundo trimestre Complicado con un Óbito Fetal de uno de sus productos de Gestación

Abstract

A multiple pregnancy is the simultaneous development in the womb two or more fetuses. The frequency classically described 1 in 80 for doubles and 1 twin 6,400 for triples. The frequency of these has increased by 70% over the past 30 years, appearing in 32.1 per 1,000 pregnancies. The causes of this increase are explained by assisted reproduction and also by increased maternal age for dizygotic twin pregnancies.

The twin pregnancy is associated with increased frequency of maternal and fetal complications. Pregnant women with twins have an increased frequency of abortions, hyperemesis gravidarum, anemia, gestational hypertension, hemorragíparos disorders and increased frequency of caesarean section. The most common fetal complications are associated with premature birth, fetal death and fetal growth restriction. Specific complications associated with fetal fetus chorionicity are transfusion and reversed arterial perfusion; and related to amnionicidad, fetal death associated with cross-linking cord in monoamniotic pregnancies.

The risk of in utero death of a twin is up to three times higher in monochorionic compared to dichorionic pregnancy. The event of the death of a twin in utero is a serious clinical problem, but rare, explaining the limited information that guides management, especially in case series.

Comparative studies agree that the risk of fetal death of one twin is more common in monochorionic gestations by vascular anastomosis and the possibility of twin-to-twin transfusion syndrome and the risk of complications for the surviving twin.

In the first quarter, spontaneous resorption of the embryo occurs between 16-43% of cases of multiple gestations. Some authors claim that 90% occurs before week 7 and never after week 13