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The Umbilical Cord and Complications of Twin Gestations

Maternal-Fetal Medicine 2022年第4期4卷 276-285页

作者： Aurianne Van Grambezen Patricia Steenhaut Bénédicte Van Grambezen frédéric debieve Pierre Bernard Corinne Hubinont department of Obstetrics Saint Luc University HospitalBrussels B-1200Belgium department of Neonatology Saint Luc University HospitalBrussels B-1200Belgium.

The rate of twin pregnancies has increased over the last decades, largely because of the ongoing development of assisted reproductive technology and increased maternal age at childbearing. Twins have a higher risk of adverse outcomes during pregnancy and the perinatal period. The prevalence of umbilical cord abnormalities is higher for twin pregnancies compared with singleton pregnancies. Some of these abnormalities are nonspecific to twinning and can also be found in singleton gestations (such as velamentous cord insertion, vasa previa, and single umbilical artery). Other abnormalities are associated with monochorionic twins, such as umbilical cord entanglement, and umbilical proximate cord insertion. Most of these abnormalities can be detected by ultrasound evaluation. The early and accurate ultrasound diagnosis of chorionicity, amnionicity, and placental and umbilical cord characteristics is crucial if we are to predict the risk of complications and to determine the best management for twin pregnancies. Histopathological examination of the placenta and umbilical cord after delivery can help to confirm prenatal diagnosis and to provide a better understanding of the physiopathology of their abnormalities. The aim of this review was to emphasize the role that the umbilical cord plays in twin complications and to describe the management of these high-risk pregnancies.

关键词： Pregnancy twin Chorionicity Cord entanglement Twin reversed arterial perfusion sequence Umbilical cord Vasa previa Velamentous cord insertion

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Elhers-danlos IV型患者妊娠期出现肾动脉瘤破裂(法)

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世界核心医学期刊文摘（妇产科学分册） 2006年第11期2卷 51-52页

作者： Tassart S. Bernard P debieve F. 李跃萍 d' epartement d'Obsté trique Hpital Universitaire Saint- Luc Université Catholique de Louvain (UCL) 10 avenue Hippocrate 1200 Bruxelles Belgium

Recall the clinical signs and personal and family medical history suggestive of Elhers-danlos syndrome, mainly type IV. Review of literature and presentation of a clinical case observed in a female patient with Elhers-danlos disease type IV who developed dissection of a renal artery during pregnancy. The prevalence of the syndrome is increasing, reaching, according to the latest publications 1/5000 births. It is important to determine the type of syndrome to assess prognosis. In the classic type and in the hyper mobile type, pregnancy is generally well tolerated although certain complications linked to connective tissue dysfunction such as pelvic instability, premature delivery, bleeding postpartum and perineal lacerations, may develop. Ehlers-danlos syndrome can be associated with serious and even fatal complications for these patients: vascular dissection or uterine rupture. It is important for obstetricians to be aware of the clinical signs and symptoms suggestive of Elhers-danlos syndrome in a pregnant patient and to know the diagnostic possibilities and potential risks. If a type IV syndrome is diagnosed, it is very important to inform the patient about the potential implications for pregnancy and maternal health, as well as the risk of transmission to the child and the possibility of antenatal diagnosis.

关键词：动脉瘤破裂血管破裂子宫破裂产后出血会阴裂伤产前诊断经典型产科医师个人史

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