HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sepulveda, W. Articles by de la Fuente, S. Search for Related Content PubMed PubMed Citation Articles by Sepulveda, W. Articles by de la Fuente, S.

Discordant Lower Urinary Tract Obstruction in Early Twin Gestations

Management and Outcome

From the ¹Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago; ²Fetal Medicine Unit, Department of Obstetrics and Gynecology, Barros Luco-Trudeau Hospital, Santiago; and ³Department of Obstetrics and Gynecology, Regional Hospital, Talca, Chile.

OBJECTIVE: To report our experience with the management of twin pregnancies discordant for lower urinary tract obstruction.

METHODS: Cases of twin pregnancies discordant for lower urinary tract obstruction were identified from our fetal medicine database. Information on ultrasonographic findings, antenatal course, pregnancy complications, and perinatal outcome was obtained by reviewing medical records or contacting the referring obstetricians.

RESULTS: Five twin pregnancies discordant for lower urinary tract obstruction were diagnosed between 11 and 15 weeks of gestation. There were 3 dichorionic and 2 monochorionic pregnancies (1 diamniotic and 1 monoamniotic). The dichorionic pregnancies were managed conservatively, resulting in a pregnancy loss of both twins in 1 case, a single fetal death at 29 weeks in 1 case, and an early neonatal death due to lung hypoplasia of the affected twin in 1 case. On the other hand, both monochorionic twin pregnancies were managed with serial vesicocenteses. In both cases, the prenatal course was complicated, 1 by premature rupture of the membranes and the other by cord entanglement, requiring delivery at 29 and 31 weeks, respectively. Among the 4 continuing pregnancies with complete perinatal outcome, none of the affected twins survived, and the structurally normal twins were delivered between 29 and 36 weeks and discharged from the hospital in good condition.

CONCLUSION: Twin pregnancies discordant for lower urinary tract obstruction are at high risk of perinatal death and premature delivery. Prenatal intervention seems not to be associated with an improved perinatal outcome of the affected twin, but it may be beneficial in selected cases to attain viability of the unaffected twin.

LEVEL OF EVIDENCE: III

This article has been cited by other articles:

				A. Casasbuenas, A. E. Wong, and W. Sepulveda Nuchal Translucency Thickness in Monochorionic Multiple Pregnancies: Value in Predicting Pregnancy Outcome J. Ultrasound Med., March 1, 2008; 27(3): 363 - 369. [Abstract] [Full Text] [PDF]