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RESUMEN Introducción: Uno de los temas que presenta más interés en los obstetras es el relacionado con la gestación gemelar. Su diagnóstico nos permite clasificarla como una gestación de riesgo, en la cual el estudio ecosonográfico es muy importante al proporcionar datos relacionados con el tipo de placentación. Presentación de caso: Se realiza ecografía prenatal del I trimestre para confirmación de diagnóstico presuntivo de onfalocele, donde se constata embarazo gemelar, monoamniótico, monocorial. Se realiza el diagnóstico de síndrome de perfusión arterial reversa feto a feto. El estado anormal del "corazón" del feto podría identificarse como una holoacardia; pero el grado de malformación que presenta no se ajusta a ninguno de los criterios de esta clasificación. Teniendo en cuenta el hallazgo precoz y la elevada mortalidad que se asocia en estos casos se sugirió la opción de interrumpir el embarazo. Conclusiones: El asesoramiento genético referido a las posibles terapias a emplear estaría limitado en este caso, debido a la alta morbimortalidad perinatal, la falta de experiencia en relación con el tratamiento medicamentoso, y la escasa disponibilidad de técnicas para la intervención fetal(AU)

ABSTRACT Introduction: One of the topics of most interest to obstetricians is related to twin pregnancy. Its diagnosis allows to classify it as a risk gestation, in which the echo-sonographic study is very important because it provides data related to the type of placentation. Case report: First trimester prenatal ultrasound is performed to confirm the presumptive diagnosis of omphalocele, revealing twin, monoamniotic, monochorial pregnancy. The diagnosis of fetus-to-fetus reverse arterial perfusion syndrome is made. The abnormal state of the fetus´s heart could be identified as a holoacardia; but the degree of malformation it presents does not fit any of the criteria of this classification. Taking into account the early finding and the high mortality associated in these cases, the option of interrupting the pregnancy. Conclusions: Genetic counseling regarding possible therapies to be used would be limited in this case, due to the high perinatal morbidity and mortality, the lack of experience in relation to drug treatment, and the limited availability of techniques for fetal intervention(AU)

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La reducción embrionaria es la interrupción selectiva del desarrollo de uno o varios fetos en el primer trimestre del embarazo. El embarazo gemelar se presenta aproximadamente en uno de cada 100 nacimientos y se considera como una entidad con alto riesgo materno y fetal. Los embarazos múltiples tienen un impacto mayor en los sistemas de salud, debido a la mayor frecuencia de complicaciones. La rotura prematura de membranas causa aproximadamente el 40 por ciento de los partos pretérmino y, como consecuencia, aportan un 10 por ciento de la mortalidad perinatal según la Sociedad Española de Ginecología y Obstetricia. En este caso clínico se observó que una actitud expectante con los pertinentes controles ecográficos (índice del líquido amniótico), analíticos (recuento leucocitario y reacción en cadena de la polimerasa) y clínicos (frecuencia cardiaca y temperatura) pueden llevar a una buena evolución posnatal que justificó al menos en esta ocasión, una actitud conservadora(AU)

Embryonic reduction is the selective interruption of the development of one or several fetuses in the first trimester of pregnancy. Twin pregnancy occurs in approximately one in every 100 births. It is considered an entity with high maternal and fetal risk. Multiple pregnancies have greater impact on health systems due to the higher frequency of complications. Premature rupture of membranes causes approximately 40 percent of preterm births and, consequently, it contributes 10 percent of perinatal mortality according to the Spanish Society of Gynecology and Obstetrics. In this clinical case it was observed that an expectant attitude with the relevant ultrasound (index of amniotic fluid), analytical (leukocyte count and polymerase chain reaction) and clinical (heart rate and temperature) controls can lead to good postnatal evolution, justified at least on this occasion, a conservative attitude(AU)

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Birth records as SINASC (Brazilian Live Birth Information System) are highlighted in uncommon conditions such as twin pregnancy whose prevalence rarely exceeds 2 to 3% of the total number of births. The objective of this study was to assess the prevalence of twin pregnancies in Brazil and their maternal and perinatal characteristics using data from the national birth e-Registry. All births in Brazil from 2011 to 2014 were assessed. Prevalence of twin pregnancies per region was assessed and correlated with the Human Development Index (HDI). Sociodemographic and obstetric factors and main perinatal outcomes were assessed for the first and second twin, in comparison to singletons, and the second twin compared to the first twin, with PR and 95%CI. A multiple logistic regression analysis was conducted to identify factors independently associated with a low 5-minute Apgar score in twin pregnancies. Twin pregnancy occurred in 1.13% in Brazil, with a higher prevalence in regions with a higher HDI. It was associated with a complete higher level of education (22.9% versus 16.3% for singles) and maternal age > 35 years (17.5% versus 11.4% for singles). Preterm birth <32 weeks (prevalence ratio-PR 12.13 [11.93 - 12.33]), low birth weight (PR 17.8 [17.6-18.0] for the first and PR 20.1 [19.8-20.3] for the second twin), and low Apgar score (PR 2.9 [2.8-3.0] for the first and PR 2.7 [2.6-2.8] for the second twin) were the most important perinatal outcomes associated with twin pregnancies. A 5-minute Apgar score < 7 among twins was associated with inadequate prenatal care, extreme preterm birth, vaginal delivery, intrapartum cesarean, and combined delivery. Twin pregnancy in Brazil is associated with worse perinatal outcomes, especially for the second twin.

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Se presenta el caso clínico de una primigesta de 21 años de edad, a quien se le detectó un embarazo gemelar monoamniótico y monocigótico en el examen ecográfico en el Centro Provincial de Genética de Santiago de Cuba. El primer feto presentaba hidronefrosis bilateral predominantemente en el lado izquierdo, y el segundo estructura fetal rudimentaria y deforme, área cardíaca mal estructurada y latidos cardíacos solo arrítmicos y bradicárdicos, además de que no se definieron los órganos internos y todo se encontraba rodeado de linfangioma quístico grave con grandes quistes paravertebrales y un solo cordón umbilical con tres vasos. Lo descrito en la ecografía se corroboró con los resultados de la necropsia, lo cual se correspondió con la variedad Acardius mylacephalus

The case report of a 21 years primigravida woman is presented to whom a monoamniotic and monochorial twin pregnancy was detected in the echographic exam at the Genetic Provincial Center of Santiago de Cuba. The first fetus presented bilateral hydronephrosis predominantly in the left side, and the second rudimentary and deformed fetal structure, not well structured heart area and just arrhythmic and bradycardiac heart beats besides that the internal organs were not defined and everything was surrounded by severe cystic lymphangioma with big paravertebral cysts and a single umbilical cord with three vessels. Everything described in the echogram was corroborated with the results of the autopsy, which corresponded with Acardius mylacephalus variety

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Introducción: Los gemelos unidos son monocigóticos, monoamnióticos, monocoriales, unidos por alguna región anatómica, resultado de una división incompleta del disco embrionario que ocurre después del día 13 de la concepción, es raro...

Introduction: The conjoinet twins are monozygotic, monoamnioticos, monochorionic joined by so meanatomical region. the result of anin complete division of the embryonic disc that occut after the 13th day of conception, is rare...

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