Dichoirial triamniotic triplets after in vitro fertilization, complicated by twins to twins transfusion syndrome and the death of two fetuses at 19 weeks of gestation: a clinical case of successful pregnancy and full-term delivery
DOI:
https://doi.org/10.15574/HW.2025.5(180).8994Keywords:
dichorionic triamniotic triplets, monochorial twins, fetal demise at 19 weeks, treatment, progesterone, managementAbstract
Triplet pregnancy after assisted reproductive technologies (ART) carries risks of complications for both the woman and the fetuses. Multiple pregnancies are becoming more common due to the widespread use of ART, particularly in vitro fertilization. Although single blastocyst transfer has become the standard, cases of monozygotic twin pregnancies and complicated multiple pregnancies remain relevant.
Aim - to present a rare clinical case of dichorionic triamniotic triplets after the use of ART, complicated by twin-to-twin transfusion syndrome (TTTS) and intrauterine death of two fetuses, as well as to analyze management tactics and perinatal outcome.
Clinical case. A 29-year-old patient underwent in vitro fertilization. After the transfer of two blastocysts, dichorial triamniotic triplets were diagnosed. At 19 weeks of pregnancy, TTTS developed in a pair of monochorionic fetuses. They died in utero, but one fetus continued to develop in its amniotic sac. The pregnancy was successfully carried to 37 weeks, delivery was by cesarean section, and the newborn was healthy. This case highlights the clinical complexity of managing dichorionic triamniotic triplets with TTTS complications and the death of two fetuses at 19 weeks. The main dilemma was whether to continue the pregnancy after the intrauterine death of two fetuses. Given the stable condition of the mother and positive dynamics of ultrasound, D-dimer, and blood counts, the pregnancy was continued. The perinatal outcome indicates the use of a personalized approach.
Conclusions. Despite the risks, the strategy of maintaining pregnancy with intrauterine monitoring showed positive results. This case may be useful for obstetricians and gynecologists who encounter similar cases.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent was obtained from all participants.
The authors declare no conflict of interest.
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