| Abstract [eng] |
Introduction: Increasing rates of multiple pregnancies are associated with older age at first conception and the use of assisted reproductive techniques to improve conception success. In vitro fertilisation is the most commonly used method. In order to ensure the success of the in vitro fertilisation procedure, more than one embryo is transferred into the uterus. More than half of all pregnancies of dichorionic diamniotic twins result from this procedure. However, this is associated with a higher incidence of complications of multiple pregnancies and fetal development. Case presentation: A 35-year-old woman became pregnant after an in vitro fertilisation (IVF) procedure in which two embryos were implanted in the uterus at 3 and 5 days. The difference in growth between the twins was observed as early as the first trimester. In the 22nd week of pregnancy, there is a 44%, 60% and 71% difference in twin growth in the 24th week and 29th week respectively. After the diagnosis of zero blood flow in the umbilical artery (arteria umbilicalis) in twin A, the patient was admitted to the antenatal clinic in the 25th week of pregnancy. During the consultation, it was decided to focus on twin B and to continue the pregnancy until the 32nd week if the situation persists. In the presence of reversed blood flow in the umbilical artery (arteria umbilicalis) of twin A, fetal lung maturation was performed at week 29. The pregnant woman was hospitalised from the 30th to the 31st week of pregnancy due to proteinuria and elevated markers of pre-eclampsia. During the hospitalization, twin A was found to have died in utero. In the 32nd week of pregnancy, the pregnant woman was hospitalised for premature amniotic fluid leakage. Consultation with an obstetrician-gynaecologist and fetal ultrasound examination revealed the death of twin A and the absence of a breech presentation of twin B. Caesarean section surgery was performed. Histological examination described one placenta with two umbilical cords, one with two and one with three vessels. Conclusion: Correct and timely diagnosis of chorionicity and amnionicity is essential to predict the incidence of complications and the care of the pregnant woman in the event of multiple pregnancies. |
