Monoamniale Mehrlings-Schwangerschaften

Zusammenfassung

Monochoriale monoamniale (MCMA) Mehrlingsschwangerschaften sind seltene Ereignisse und betreffen circa 0,004% aller Lebendgeburten. Die Pathogenese wird in einer verzögerten Teilung der Zygote gesehen, jedoch ist die genaue Ätiologie noch unklar. Nach artifizieller Befruchtung kommt es zu einer erhöhten Inzidenz. Die Diagnose von MCMA Mehrlingsschwangerschaften per se sowie den damit verbundenen Komplikationen wie Nabelschnurumschlingung, Fehlbildungen inklusive verschiedener Formen von siamesischen Mehrlingen, der erhöhten Frühgeburtsneigung sowie von Transfusionssyndromen hat sich durch moderne Ultraschall-Untersuchungsmethoden verbessert. Durch Intensivierung der Überwachung konnten die Überlebenschancen bis auf 80–90% verbessert werden. Als Entbindungsmodus wird international die primäre Sektio bei ca. 32 Wochen empfohlen, auch wird dies in Deutschland nicht immer so praktiziert. Postnatale plazentare Untersuchungen der Anastomosen haben zu weiteren Erkenntnissen der Pathophysiologie von MCMA Mehrlingsschwangerschaften beigetragen.

Abstract

Monochorionic monoamniotic (MCMA) multiple pregnancies are rare events with an incidence of around 0.004% of all life births. They are the result of a delayed splitting of a single blastocyst whereby the stimuli and mechanisms are still unknown.

The Incidence of MCMA multiple pregnancies is increased after artificial reproductive techniques. With the advent of modern ultrasonography the diagnosis of MCMA multiple pregnancies and the combined complications such as cord entanglement, malformations including the incidence if conjoined twins and even threatening preterm delivery or twin-twin transfusion syndrome has improved.

The chances of intact survival of up to 80–90% have improved through intensified surveillance. It is recommended to perform a Cesarean section at around 32 gestational weeks. Postnatal investigations of the placenta and its anastomoses have increased our understanding of the pathophysiology of MCMA multiple pregnancies.

Schlüsselwörter

Monoamniale Mehrlingsschwangerschaften - Perinatale Mortalität - Fetale Überwachung

Key words

monoamniotic multiple pregnancies - perinatal Mortality - fetal surveillance

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