Case Report: Dichorionic twins pregnancy with placenta abruption

Introduction

The existence of two unique chorions, signifying the development of distinct placental structures for each fetus, is a characteristic of dichorionic twin pregnancies. Placental abruption, which is the early separation of the placenta from the uterine wall, is a rare but potentially fatal pregnancy problem. Dichorionic twin gestation is becoming increasingly complicated to manage, necessitating close observation and prompt action.¹ In the context of multiple pregnancies, dichorionic pregnancy is a rare and intriguing event in which a woman carries twins, each of which has its own distinct chorionic sac. One of the fetal membranes envelops the growing embryo and eventually gives rise to the outermost layer of the placenta. When a pregnancy is dichorionic, there are two different types of chorionic sacs, indicating that the twins have separate amniotic sacs, which house and shield them during pregnancy, in addition to being genetically unique.²

Soon after fertilization, the fertilized egg divides into two embryos, resulting in this type of pregnancy. Each embryo develops autonomously, acquiring unique genetic material and corresponding anatomical features. Monochorionic pregnancies, in which twins share a single chorionic sac, are sometimes compared to dichorionic pregnancies.³ Comprehending the chronicity of a twin pregnancy is essential for appropriate prenatal care and treatment, as it affects the developing fetuses’ and mothers’ overall health outcomes, as well as risk factors and complications.⁴

During dichorionic pregnancy, medical professionals keep a close eye on the development and health of each twin for the best possible prenatal care. Dichorionic pregnancies are of great interest in obstetrics and reproductive medicine because of their unique nature, which adds to variances in the timing of some developmental milestones and associated difficulties.⁵

Premature placental separation from the uterine wall before birth can result in placental abruption, which is a dangerous and potentially fatal condition. Despite being relatively uncommon, this illness puts the developing fetus and mother at serious risk. The placenta is essential for the development of a baby’s nutrition and oxygen supply, and any interference in its regular operation can have major consequences.⁶

Usually presenting as abrupt and severe stomach pain and vaginal bleeding, placental abruption can lead to severe fetal suffering within the foetus. Placental abruption can range in severity from mild cases with few symptoms to severe cases with serious and immediate effects on the health of the mother and fetus. To reduce related risks and improve the results for the mother and the unborn child, prompt recognition and action are essential.⁷

Case presentation

We present a case of a 32-year-old primigravida who complained of vaginal bleeding and abrupt onset of stomachache. After ultrasound examination at 10 weeks of gestation, it was determined she was carrying dichorionic twins (Figures 1 and 2). The patient had been receiving routine prenatal care and the pregnancy was straightforward before this presentation. The patient’s vital signs were stable at admission, but an examination of her abdomen showed that she had uterine pain and a fundal height that was normal for her gestational age. Both fetuses had comforting heartbeats according to fetal heart rate monitoring. Retroplacental bleeding and irregular blood flow are among the symptoms of placental abruption detected by transabdominal ultrasonography.

Figure 1. Image of Twin 1.

Figure 2. Image of Twin 2.

Discussion

Placental abruption in dichorionic twin pregnancies is problematic because the health of the mother and fetus must be closely monitored. Improving results depends on prompt diagnosis and intervention. In the management of such complicated pregnancies, this example emphasizes the value of a multidisciplinary approach involving obstetricians, neonatologists, and haematologists.⁸

When fertilization produces two distinct embryos, each with its own amniotic sac and chorionic membrane, the result is dichorionic pregnancy. For example, twin gestations are more likely to experience this condition. The dichorionic twins in question have separate blood supplies and locations on their bodies, which creates a special setting for the eventual development of placental abruption.⁹

Early detachment of the placenta from the uterine wall, known as placental abruption, compromises fetal oxygenation and causes maternal haemorrhage. It is an uncommon but serious consequence that may arise from a number of risk factors such as trauma, maternal hypertension, or anomalies in the placental anatomy. In this case, the elevated risk of placental abruption might have been influenced by the presence of hypertension.¹⁰

Theoretically, the autonomy with which placentas in dichorionic pregnancies lessens the chance that a single placental abnormality may damage both fetuses. Nonetheless, the fact that one fetus had placental abruption draws attention to the complexity of this situation. Managing one fetus’s impaired blood flow while safeguarding the health of the unaffected co-twin is a special difficulty.¹¹

Conclusion

The effective care of dichorionic twin pregnancies complicated by placental abruption is highlighted in this case study. A multidisciplinary approach, prompt intervention, and continuous monitoring have led to good results in mothers and newborns. To improve our understanding of the best management practices for scenarios comparable to this, more research and reporting are required.