Vanished twin syndrome

Out of a vanished twin is a fetus that dies in utero multigemelara task and is then partially or completely absorbed by the mother or brother. The appearance of this phenomenon is called unoeri embolism syndrome twin or twin syndrome disappeared.
Occasionally instead of complete absorption, dead fetus is compressed by up intro brother pergamantoasa structure, known as fetus papyraceus payment. If the fetus is completely absorbed no further complications for pregnancy, except for first trimester bleeding.If the event occurs in the second or third trimester of pregnancy severe complications may include premature labor, infection and bleeding by removing the fetus. Even at the end of pregnancy, a fetus can block the cervix and makes papyraceus necessary cesarean.
Vanished twin can die due to a poorly implanted placenta, an abnormality that can cause major organ failure or complete lack thereof in the fetus or there may be a chromosomal abnormality incompatible with life. Gemini is a frequently empty egg which develops over the early stages of embryogenesis ever.
Sidnromului frequency is one of 8 tasks and may remain unknown in many cases. The phenomenon occurs frequently in tasks created as a result of in vitro insemination.Early ultrasound scans are performed in these tasks, so if multiple conception occurred can be seen more than one amniotic sac in the first week and after a certain period brothers disappear.
PathophysiologyAbnormalities that cause the disappearance of a fetus seem to be present in the earliest moments of development only after an acute injury. Analysis of fetal or placental chromosomal abnormalities often show. These abnormalities include diploidiile, and alternating triploidiile chromosomes are highlighted in placental tests, skin biopsies and chorionic choriale. Chromosome studies are normal viable twin.Therefore it is considered that vanished twin had a chromosomal abnormality.
Mechanisms surviving twin complications:Cerebral Palsy:Researchers have proposed that the missing twin syndrome can cause cerebral palsy spastic brother viable. A possible mechanism is the twin transfusion protein tromboplastice dead at viable, disseminated intravascular coagulation leading to. CID is assumed that by reversing the flow of blood resulting from steep at viable brother, wearing tromboplastinele in circulation. This load is considered large thromboplastin leads to a viable fetus the status of CID in the central nervous system damage.Another theory proposed is the effect of large amount of blood lost by brother viable low resistance to the vascular system of the dead through placental anastomoses. This transfusion can cause wide fluctuations in intravascular pressures and intravascular hemorrhage leading to cerebral palsy.
Cutis aplasia:Aplasia cutis mechanism is vascular development, with decreased perfusion in the area affected by the death of his brother.
Signs and symptomsVanished twin syndrome pregnancies is to identify a secondary multifetale the disappearance of one or more fetuses. Multifetale pregnancy after conception rate is higher than the incidence noted at birth. Vanished twin syndrome was identified more frequently since the introduction of echography in early pregnancy. IVF techniques have improved understanding sidnromului because these tasks are carefully monitored and the number of implanted fertilized zygote is unknown.The missing twin syndrome may occur total fetal resorption, formation of a fetus papyraceus (mummified and compressed fetus) or the development of subtle abnormalities of the placenta as a cyst, or fibrin subchorionica amorphous material.
First quarter:Morbidity varies phenomenon in the first quarter. It is usually limited. The mother is prone to the development of vaginal bleeding and mild cramps. If the event occurs late morbidity may be similar to the second or third quarter.
Second or third quarter:Maternal complications include preterm labor, infection with retained fetus, severe puerperal hemorrhage, consumptive coagulopathy and the birth canal obstruction that causes dystocia papyraceus printrun fetus and require cesarean section.
The disease:Sync this event significantly affect maternal outcome and complications viable twin. If the event occurs in the second half of pregnancy, the fetus may develop cerebral palsy or cutis aplasia, and the mother can devzolta premature birth, infection, hemorrhage puerperium, consumptive coagulopathy or block delivery.
DiagnosisLaboratory studies:Recent phenomenon-associated plasma protein increases beta-HCG pregnancy and freeAlpha-fetoprotein is increased from a normal pregnancyHuman chorionic gonadotrophin-growth rate is lower than a normal pregnancy.
Imaging Studies:Ultrasound is used to confirm the diagnosis of twins early. Tracking patient shows loss of a fetus by ultrasound in the evolution of pregnancy.Amniocentesis after diagnosis of a fetus by ultrasound history disappear detect XY cells FISH and PCR technique.Vili Biospia chorionic placenta is useful if you have a mosaic pattern at birth but ezista one product.Differential diagnosis is made with the following conditions: spontaneous abortion, deciduous reaction to ultrasound, amniotic cavity seen in ultrasound as a second fetus, chorionic sac considered the second fetus, celom extraembrionic observed as the second fetus, hemorrhage subchorionica or modification of Vili considered hydropathicthe second fetus.
TreatmentIf a fetus is outstanding papyraceus, pregnancy should be monitored closely by serial echography to evaluate the viable fetus. Risks include premature labor, or birth canal obstruction surviving fetus death by chorioamnionitis or rupture of the placenta. The fetus is at risk of low birth weight and gestational age. Disappeared uncomplicated twin syndrome does not require special medical care.
Prognosis:In addition to the loss of a twin fetus that survives at increased risk of cerebral palsy, especially if the missing twin syndrome occurs in the second half of pregnancy. Other forms of reported morbidity in twin survives is aplasia cutis or which areas of skin necrosis. The brothers connected by placental vascularization by anastomosis, viable twin transient hypotension at the time of death leads to poor perfusion and skin necrosis.