<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2 20190208//EN" "http://jats.nlm.nih.gov/publishing/1.2/JATS-journalpublishing1.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" article-type="case-report" dtd-version="1.2" xml:lang="en">
    <front>
        <journal-meta>
            <journal-id journal-id-type="pmc">F1000Research</journal-id>
            <journal-title-group>
                <journal-title>F1000Research</journal-title>
            </journal-title-group>
            <issn pub-type="epub">2046-1402</issn>
            <publisher>
                <publisher-name>F1000 Research Limited</publisher-name>
                <publisher-loc>London, UK</publisher-loc>
            </publisher>
        </journal-meta>
        <article-meta>
            <article-id pub-id-type="doi">10.12688/f1000research.145330.1</article-id>
            <article-categories>
                <subj-group subj-group-type="heading">
                    <subject>Case Report</subject>
                </subj-group>
                <subj-group>
                    <subject>Articles</subject>
                </subj-group>
            </article-categories>
            <title-group>
                <article-title>Case Report: Dichorionic twins pregnancy with placenta abruption</article-title>
                <fn-group content-type="pub-status">
                    <fn>
                        <p>[version 1; peer review: awaiting peer review]</p>
                    </fn>
                </fn-group>
            </title-group>
            <contrib-group>
                <contrib contrib-type="author" corresp="no">
                    <name>
                        <surname>Raut</surname>
                        <given-names>Kajal</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Writing &#x2013; Original Draft Preparation</role>
                    <uri content-type="orcid">https://orcid.org/0009-0001-2333-8296</uri>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <contrib contrib-type="author" corresp="yes">
                    <name>
                        <surname>Thool</surname>
                        <given-names>Bali</given-names>
                    </name>
                    <role content-type="http://credit.niso.org/">Supervision</role>
                    <xref ref-type="corresp" rid="c1">a</xref>
                    <xref ref-type="aff" rid="a1">1</xref>
                </contrib>
                <aff id="a1">
                    <label>1</label>Obstetrics and Gynaecology, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India</aff>
            </contrib-group>
            <author-notes>
                <corresp id="c1">
                    <label>a</label>
                    <email xlink:href="mailto:bnthool@rediffgmail.com">bnthool@rediffgmail.com</email>
                </corresp>
                <fn fn-type="conflict">
                    <p>No competing interests were disclosed.</p>
                </fn>
            </author-notes>
            <pub-date pub-type="epub">
                <day>23</day>
                <month>4</month>
                <year>2024</year>
            </pub-date>
            <pub-date pub-type="collection">
                <year>2024</year>
            </pub-date>
            <volume>13</volume>
            <elocation-id>341</elocation-id>
            <history>
                <date date-type="accepted">
                    <day>8</day>
                    <month>3</month>
                    <year>2024</year>
                </date>
            </history>
            <permissions>
                <copyright-statement>Copyright: &#x00a9; 2024 Raut K and Thool B</copyright-statement>
                <copyright-year>2024</copyright-year>
                <license xlink:href="https://creativecommons.org/licenses/by/4.0/">
                    <license-p>This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
                </license>
            </permissions>
            <self-uri content-type="pdf" xlink:href="https://f1000research.com/articles/13-341/pdf"/>
            <abstract>
                <p>Pregnancies involving dichorionic twins have been recognized for their distinct difficulties and complications. The care and outcomes of such pregnancies are further complicated by placental abruption, an uncommon but significant obstetric event. We describe a case of placental abruption in a dichorionic twin pregnancy, including the clinical manifestations, diagnosis, treatment, and prognosis of the mother and fetus.</p>
                <p>Pregnancies with two separate chorions, or dichorionic pregnancies, are a special type of multiple gestation. Early separation of the placenta from the uterine wall is a potentially fatal event that can have a major influence on the health of both the mother and fetus. It is a key complication of placental abruption.</p>
                <p>We describe a 32-year-old primigravida who complained of sudden onset abdominal pain and vaginal bleeding at 28 weeks of gestation. She had dichorionic twin pregnancy after 10 weeks of gestation, as determined by ultrasonography.</p>
                <p>The patient remained stable, and repeated ultrasounds verified that there was no further placental separation. The patient underwent an elective caesarean section at 35 weeks of gestation because of a higher risk of recurrent abruption. Two healthy newborns were delivered, and their weights were consistent with their gestational age.</p>
            </abstract>
            <kwd-group kwd-group-type="author">
                <kwd>KEYWORDS: twin gestation</kwd>
                <kwd>placental abruption</kwd>
                <kwd>prenatal care</kwd>
                <kwd>perinatal outcome</kwd>
                <kwd>dichorionic pregnancy.</kwd>
            </kwd-group>
            <funding-group>
                <funding-statement>The author(s) declared that no grants were involved in supporting this work.</funding-statement>
            </funding-group>
        </article-meta>
    </front>
    <body>
        <sec id="sec1" sec-type="intro">
            <title>Introduction</title>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref1">1</xref>
                </sup> 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.
                <sup>
                    <xref ref-type="bibr" rid="ref2">2</xref>
                </sup>
            </p>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref3">3</xref>
                </sup> Comprehending the chronicity of a twin pregnancy is essential for appropriate prenatal care and treatment, as it affects the developing fetuses&#x2019; and mothers&#x2019; overall health outcomes, as well as risk factors and complications.
                <sup>
                    <xref ref-type="bibr" rid="ref4">4</xref>
                </sup>
            </p>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref5">5</xref>
                </sup>
            </p>
            <p>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&#x2019;s nutrition and oxygen supply, and any interference in its regular operation can have major consequences.
                <sup>
                    <xref ref-type="bibr" rid="ref6">6</xref>
                </sup>
            </p>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref7">7</xref>
                </sup>
            </p>
        </sec>
        <sec id="sec2">
            <title>Case presentation</title>
            <p>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 (
                <xref ref-type="fig" rid="f1">Figures 1</xref> and 
                <xref ref-type="fig" rid="f2">2</xref>). The patient had been receiving routine prenatal care and the pregnancy was straightforward before this presentation. The patient&#x2019;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.</p>
            <fig fig-type="figure" id="f1" orientation="portrait" position="float">
                <label>Figure 1. </label>
                <caption>
                    <title>Image of Twin 1.</title>
                </caption>
                <graphic id="gr1" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/159264/78733c0b-adb7-4acd-a11c-aa11af47117b_figure1.gif"/>
            </fig>
            <fig fig-type="figure" id="f2" orientation="portrait" position="float">
                <label>Figure 2. </label>
                <caption>
                    <title>Image of Twin 2.</title>
                </caption>
                <graphic id="gr2" orientation="portrait" position="float" xlink:href="https://f1000research-files.f1000.com/manuscripts/159264/78733c0b-adb7-4acd-a11c-aa11af47117b_figure2.gif"/>
            </fig>
            <sec id="sec3">
                <title>Diagnostic assessment</title>
                <p>The total blood count, coagulation profile, Doppler ultrasonography, and continuous electronic fetal monitoring are among the confirmatory tests
                    <bold>.</bold> Placental abruption was confirmed as the cause of the modest drop in haemoglobin and high fibrin degradation product level observed in laboratory examinations.</p>
            </sec>
            <sec id="sec4">
                <title>Management</title>
                <p>The patient was moved immediately to a tertiary care centre with a newborn critical care unit. Corticosteroids were administered for fetal lung maturation according to gestational age. An emergency caesarean section was planned when the mother&#x2019;s or fetus&#x2019;s circumstances worsened. Continuous fetal monitoring and maternal observation were initiated.</p>
                <p>After close observation for 48 hours, the patient&#x2019;s symptoms subsided and fetal health was preserved. Strict bed rest regulations and vigilant monitoring are part of the ongoing conservative care.</p>
            </sec>
            <sec id="sec5">
                <title>Outcome</title>
                <p>The patient remained stable, and repeated ultrasounds verified that there was no further placental separation. Because of concerns about the increased risk of repeated abruption, the patient underwent an elective caesarean section performed at 35 weeks of gestation. Two healthy newborns were delivered, and their weights were consistent with their gestational age.</p>
            </sec>
        </sec>
        <sec id="sec6" sec-type="discussion">
            <title>Discussion</title>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref8">8</xref>
                </sup>
            </p>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref9">9</xref>
                </sup>
            </p>
            <p>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.
                <sup>
                    <xref ref-type="bibr" rid="ref10">10</xref>
                </sup>
            </p>
            <p>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&#x2019;s impaired blood flow while safeguarding the health of the unaffected co-twin is a special difficulty.
                <sup>
                    <xref ref-type="bibr" rid="ref11">11</xref>
                </sup>
            </p>
        </sec>
        <sec id="sec7" sec-type="conclusion">
            <title>Conclusion</title>
            <p>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.</p>
            <sec id="sec8">
                <title>Patient consent</title>
                <p>The patient and the patient&#x2019;s family gave written informed consent so that case details could be shared and this case report could be published.</p>
            </sec>
            <sec id="sec9">
                <title>Perspective of patient</title>
                <p>Being in dichorionic pregnancy and having an abrupt placenta has been an extremely difficult and stressful experience. There was a mixture of elation and trepidation when we learned that we expected twins. The excitement I knew that two tiny lives were developing inside me was always balanced with the knowledge that a multiple pregnancy carries more hazards.</p>
                <p>The already problematic scenario became even more anxious when it was revealed that placental abruption had occurred. It was like I were walking a tightrope, trying to strike a balance between the prospect of issues and my expectation for a smooth pregnancy. A surge of anxiety and doubt was brought on by the placenta&#x2019;s early separation from the uterine wall, since it was believed that this condition could endanger the health of both newborns, and each visit became an anxious and tense experience, full with dread and expectation. The emotional rollercoaster was heightened by ongoing medical testing, monitoring, and discussions about possible consequences.</p>
            </sec>
        </sec>
    </body>
    <back>
        <sec id="sec12" sec-type="data-availability">
            <title>Data availability</title>
            <p>No data are associated with this article.</p>
        </sec>
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</article>
