EP12.05: Monochorionic twin pregnancy in bicornuate uterus

Abstract

We present the case of a 31 year old primigravida with a history of infertility. Evaluating the causes of infertility we found only a bicornuate uterus at US examination. The bicornuate uterus is known as a cause for a higher risk of spontaneous abortion and premature birth. She became pregnant and the transvaginal US revealed a twin pregnancy in the right hemiuterus. At the nuchal scan at 13 weeks we observed a biamniotic monochorial pregnancy with a high risk for aneuploidies but the karyotype was normal at 17 weeks after amniocentesis (CVS cannot be performed at 13 weeks due to the uterine abnormality and posterior position of the placenta). We started prenatal birth prophilaxia with vaginal progesterone (cervical length 25 mm). The 20 weeks morphologic scan was normal for both fetuses but the cervix became shorter (20 mm). During the second trimester the pregnancy evolution was normal, with a high uterine tonus but without contractions, without signs of Twin–twin transfusion syndrome but a tendency towards selective intrauterine growth restriction. At 24 weeks the weight of both fetuses was inside the normal range, at 20th and, respectively, 10th centile for the smaller, with a 20% weight discordance. At 28 weeks one fetus was below the 10th centile, the weight discordance was 25%, with a present diastolic forward flow (sIUGR type 1). At this scan the cervix had 15 mm with an open internal os, no contractions. The follow-up became biweekly and the corticotherapy was started. At 32 weeks the patient was examined for moderate bleeding and high uterine tonus without contractions and we observed an effaced cervix, 4 cm dilated, the first, lower fetus, in breech presentation and the second, upper fetus, in cranial presentation. For these reasons we performed Caesarean section for two girls in good condition, of 1000 grams and 1400 grams, respectively. Both girls needed respiratory and nutrition support but the outcome was good, being released at home after 47 days. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.