Die monochoriale Zwillingsgravidität und ihre Problematik

Zusammenfassung

Monochoriale Zwingsschwangerschaften weisen ein erhöhtes Risiko für intrauterine und postnatale Komplikationen infolge von plazentaren Gefäßanastomosen auf. Die Hauptprobleme sind die Entwicklung eines fetofetalen Transfusionssyndroms, einer selektiven intrauterinen Wachstumsrestriktion, von monoamnialen Zwillingen und eines intrauterinen Fruchttodes eines Zwillings. Des Weiteren sind monochoriale Zwillinge durch kongenitale Anomalien wie die TRAP-Sequenz und siamesische Zwillinge kompliziert. Die fetoskopische Lasertherapie mit selektiver Koagulation von plazentaren Gefäßanastomosen stellt derzeit die Therapie der Wahl in der Behandlung des fetofetalen Transfusionssyndroms dar. Bei monochorialen Zwillingsschwangerschaften besteht ein erhöhtes Risiko für eine Frühgeburt, für zerebrale Schädigungen sowie neuromotorischen Entwicklungsstörungen in der Langzeitzeitbeobachtung.

Abstract

Monochorionic twin pregnancies have an increased risk of intrauterine and postnatal complications because of the present placental vascular anastomoses. The main problems are the development of twin-to-twin transfusion syndrome, selective intrauterine growth restriction, monoamniotic twins and single intrauterine death on the one hand and congenital abnormalities like twin reversed-arterial perfusion and conjoined twins on the other hand. Fetoscopic laser therapy with selective coagulation of placental intertwin anastomoses is the best option in the treatment of twin-to-twin transfusion syndrome. The risk of preterm delivery, cerebral injury and abnormalities of long-term neurodevelopmental outcome are increased. Perinatal management of monochorionic twin pregnancies should be performed in specialized tertiar centers.

Schlüsselwörter

monochoriale Zwillingsschwangerschaft - fetofetales Transfusionssyndrom - TRAP-Sequenz - Morbidität

Key words

monochorionic twin pregnancy - twin-twin transfusion syndrome - TRAP-Sequence - morbidity

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