[Specific placental complications of monochorionic diamniotic twins born after 24 weeks of pregnancies - restrospective analysis]. / Specifické placentární komplikace u monochoriálních biamniálních dvojcat porozených po 24. týdnu gravidity - retrospektivní analýza.

OBJECTIVE: Purpose of this study was to determine the frequency of occurence of specific complications of monochorionic diamniotic twins born after 24 weeks of pregnancies and the effect of these complications on perinatal morbidity and mortality. TYPE OF STUDY: Restrospective analysis. SETTING: Dpt. of Obstetrics and Gynecology Masaryk University and University Hospital Brno. METHODOLOGY: A retrospective analysis of 175 monochorionic diamniotic pregnancies (mo-bi), which were terminated after the 24th week of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno between the years 2008-2013. The specific complications such as twin-to-twin syndrome (TTTs), twin anemia polycytemia sequens (TAPS), selective intrauterine growth restriction (sIUGR), twin-arterial revers perfusion sequence (TRAP), single intrauterine fetal death (IUFD), placental insufficiency with both twins were identified using prenatal ultrasound examinations, perinatal results and the result of pathological anatomical examinations. Perinatal morbidity, neonatal mortality and neurological development were evaluated. The numbers of late detections of specific complications were observed. RESULTS: Specific complications in our group were identified in 50 pregnancies (28.6%). TTTs was diagnosed most often, by 18 pregnancies (10.3%), next most frequent diagnosis were sIUGR (9.7%) and TAPS (3.4%). The placental insufficiency with both twins complicated 2.6% pregnancies. 10 children had abnormal neurological development. Pregnancies with late detection had the worst perinatal results. No acute TTTs during delivery was detected. CONCLUSION: Specific placental complication reached 29.7% in our file. The most frequent complication was TTTs (10.3%) and selective growth restriction (9.7%). Pregnancies with late diagnosis of these complications had the worst results. The prenatal care by monochorial biamnial pregnancies should be at specialized centres from the 16th week of pregnancy every two weeks.

[The influence of breach position of the second twinon perinatal outcomes in vaginal births of bichorial - biamniotic twins after 33rd week of gravidity]. / Vliv naléhání druhého dvojcete koncem pánevním na perinatální výsledky pri vaginálním vedení porodu bichoriálních biamniálních dvojcat po 33. týdnu gravidity.

OBJECTIVE: The objective is to evaluate whether a breach presentation of the second twin has an influence on the perinatal results in vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno. SAMPLE AND METHODS: The current study is a retrospective analysis of 695 vaginal births of bichorial-biamniotic twins after 33rd week of pregnancy. All births were conducted at the Department of Obstetrics and Gynecology, Masaryk University and University Hospital Brno during the span of 2004-2013. The sample was divided into2 groups. Group A consisted of 550 births of both twins in vertex presentation, group B consisted of 145 births in which the second twin happened to be in the breach presentation. The factors that have been evaluated include the percentage of births finished vaginally, perinatal results (pH a. umbilicalis below 7.0 and Apgar score in the 5th minute below 5) and early neonatal mortality and morbidity. Data from both groups have been compared with the use of Fishers exact test. RESULTS: For the group A, 81.3% of births were finished vaginally, as opposed to 85.5% in group B. Acute Caesarean sections conducted on the second twin consisted 4% (22 cases) in group A and 3.4% (5 cases) in group B. No significant difference has been found between the two groups in both perinatal results (p = 0.6 for pH from a. umbilicalis below 7.0 and p = 0.7 for Apgar score in the 5th minute below 5; both two-tailed) and in the frequency of early neonatal mortality and morbidity. In total,5 neonatal deaths have occured in 28 days after birth, out of which 2 have occured in group A and 3 in group B. CONCLUSION: It was concluded that breach presentation of the second twin does not influence perinatal results in vaginal births of bichorial-biamniotic twins. KEYWORDS: bichorial-biamniotic twins, vaginal birth, breach presentation, perinatal mortality, perinatal morbidity.