Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2022 | Twin-to-Twin Transfusion Syndrome | Case report

Rare spontaneous monochorionic dizygotic twins: a case report and a systematic review

Authors: Giulia Trombetta, Dora Fabbro, Eliana Demori, Lorenza Driul, Giuseppe Damante, Serena Xodo

Published in: BMC Pregnancy and Childbirth | Issue 1/2022

Abstract

Background

Monochorionic dizygotic twins are a rare condition, mostly related to assisted reproductive technology. This type of twinning is burdened by the same risk of pregnancy complications found in monochorionic monozygotic pregnancies.

Case presentation

We report a case of spontaneous monochorionic dizygotic twins sharing situs inversus abdominalis and isolated levocardia, with only one twin affected by biliary atresia with splenic malformation syndrome. We also conducted a literature review of the 14 available documented monochorionic dizygotic twin gestations spontaneously conceived.

Conclusions

It is still unclear how this unusual type of twinning can occur in spontaneous conception. The evidence so far suggest the importance to timely diagnose the chorionicity, in order to adequately manage the typical complications associated with monochorionicity.

Available only for authorised users

Peters HE, König TE, Verhoeven MO, Schats R, Mijatovic V, Ket JC, Lambalk CB. Unusual Twinning Resulting in Chimerism: A Systematic Review on Monochorionic Dizygotic Twins. Twin Res Hum Genet. 2017;20(2):161–8. https://doi.org/10.1017/thg.2017.4. Epub 2017 Feb 27. PMID: 28236812.CrossRefPubMed

Lopez-Tello J, Sferruzzi-Perri AN. Fused placentas: till birth do us part. Placenta. 2021;1(103):177–9. https://doi.org/10.1016/j.placenta.2020.10.036. Epub 2020 Nov 2. PMID: 33157350.CrossRef

Galjaard S, Moerman P, Corveleyn A, Devlieger R, Lewi L. Partial monochorionic and monoamniotic twin pregnancies: a report of two cases. Ultrasound Obstet Gynecol. 2014;44:722–4. https://doi.org/10.1002/uog.13403.CrossRefPubMed

Nylander PP, Osunkoya BO. Unusual monochorionic placentation with heterosexual twins. Obstet Gynecol. 1970;36(4):621–5. PMID: 5506469.PubMed

Quintero RA, Mueller OT, Martínez JM, Arroyo J, Gilbert-Barness E, Hilbelink D, Papenhausen P, Sutcliffe M. Twin-twin transfusion syndrome in a dizygotic monochorionic-diamniotic twin pregnancy. J Matern Fetal Neonatal Med. 2003;14(4):279–81. https://doi.org/10.1080/jmf.14.4.279.281. PMID: 14738176.CrossRefPubMed

Shalev SA, Shalev E, Pras E, Shneor Y, Gazit E, Yaron Y, Loewenthal R. Evidence for blood chimerism in dizygotic spontaneous twin pregnancy discordant for Down syndrome. Prenat Diagn. 2006;26(9):782–4. https://doi.org/10.1002/pd.1503. PMID: 16927328.CrossRefPubMed

Lattanzi W, De Vincenzo RP, De Giorgio F, Stigliano E, Capelli A, Arena V. An acephalus acardius amorphous fetus in a monochorionic pregnancy with sex discrepancy. Twin Res Hum Genet. 2006;9(5):697–702. https://doi.org/10.1375/183242706778553453. PMID: 17032553.CrossRefPubMed

Hackmon R, Jormark S, Cheng V, O’Reilly Green C, Divon MY. Monochorionic dizygotic twins in a spontaneous pregnancy: a rare case report. J Matern Fetal Neonatal Med. 2009;22(8):708–10. https://doi.org/10.1080/14767050902763159. PMID: 19562637.CrossRefPubMed

Umstad MP, Short RV, Wilson M, Craig JM. Chimaeric twins: why monochorionicity does not guarantee monozygosity. Aust N Z J Obstet Gynaecol. 2012;52(3):305–7. https://doi.org/10.1111/j.1479-828X.2012.01445.x. Epub 2012 May 8. PMID: 22563999.CrossRefPubMed

10.

Kanda T, Ogawa M, Sato K. Confined blood chimerism in monochorionic dizygotic twins conceived spontaneously. AJP Rep. 2013;3(1):33–6. https://doi.org/10.1055/s-0032-1331377. Epub 2013 Jan 2. PMID: 23943707; PMCID: PMC3699156.CrossRefPubMedPubMedCentral

11.

Rodriguez-Buritica D, Rojnueangnit K, Messiaen LM, Mikhail FM, Robin NH. Sex-discordant monochorionic twins with blood and tissue chimerism. Am J Med Genet A. 2015;167A(4):872–7. https://doi.org/10.1002/ajmg.a.37022. Epub 2015 Feb 23. PMID: 25708669.CrossRefPubMed

12.

Gabbett MT, Laporte J, Sekar R, Nandini A, McGrath P, Sapkota Y, Jiang P, Zhang H, Burgess T, Montgomery GW, Chiu R, Fisk NM. Molecular Support for Heterogonesis Resulting in Sesquizygotic Twinning. N Engl J Med. 2019;380(9):842–9. https://doi.org/10.1056/NEJMoa1701313. PMID: 30811910.CrossRefPubMed

13.

Chen K, Kuhlmann R, Bell A, Rader J, Baumgartner M, Lemmens K, Merrill D. Twin anemia-polycythemia sequence in sex-discordant monochorionic dizygotic twins. Ultrasound Obstet Gynecol. 2020;56(3):461–2. https://doi.org/10.1002/uog.22073. PMID: 32395871.CrossRefPubMed

14.

Armitage AM, Kundra MA, Ghiam N, Atwal PS, Morel D, Hruska KS, Torene R, Harbour JW, Forghani I. Chimerism involving a RB1 pathogenic variant in monochorionic dizygotic twins with twin-twin transfusion syndrome. Am J Med Genet A. 2021;185(1):208–12. https://doi.org/10.1002/ajmg.a.61913. Epub 2020 Oct 9. PMID: 33037780.CrossRefPubMed

15.

Daum H, Frumkin A, Meiner V, Werner M, Macarov M, Gillis D, Israel S, Abed El Latif M, Meir K, Gielchinsky Y. Non-confined long-standing blood chimerism in a spontaneous monochorionic dizygotic twin pregnancy. Int J Gynaecol Obstet. 2020;148(3):399–400. https://doi.org/10.1002/ijgo.13022. Epub 2019 Nov 26. PMID: 31671208.CrossRefPubMed

16.

Yoshida A, Kaji T, Sogawa E, Yonetani N, Suga K, Nakagawa R, Iwasa T. Monochorionic Dizygotic Twins Conceived Spontaneously Showed Chimerism in Karyotype and Blood Group Type. Twin Res Hum Genet. 2021;24(3):184–6. https://doi.org/10.1017/thg.2021.20. Epub 2021 Jun 15. PMID: 34127172.CrossRefPubMed

17.

Chen J, Xu J, Chen ZH, Yin MN, Guo XY, Sun L. Case Report: Identification of Germline Chimerism in Monochorionic Dizygotic Twins. Front Genet. 2021;19(12):744890. https://doi.org/10.3389/fgene.2021.744890. PMID:34868215;PMCID:PMC8641794.CrossRef

18.

Ginsberg NA, Ginsberg S, Rechitsky S, Verlinsky Y. Fusion as the etiology of chimerism in monochorionic dizygotic twins. Fetal Diagn Ther. 2005;20(1):20–2. https://doi.org/10.1159/000081363. PMID: 15608454.CrossRefPubMed

19.

Aoki R, Honma Y, Yada Y, Momoi MY, Iwamoto S. Blood chimerism in monochorionic twins conceived by induced ovulation: case report. Hum Reprod. 2006;21(3):735–7. https://doi.org/10.1093/humrep/dei379. Epub 2005 Nov 3. PMID: 16269445.CrossRefPubMed

20.

Mayeur Le Bras A, Petit F, Benachi A, Bedel B, Oucherif S, Martinovic J, Armanet N, Tosca L, Gautier V, Parisot F, Labrune P, Tachdjian G, Brisset S. Confined blood chimerism in a monochorionic dizygotic sex discordant twin pregnancy conceived after induced ovulation. Birth Defects Res A Clin Mol Teratol. 2016;106(4):298–303. https://doi.org/10.1002/bdra.23457. Epub 2016 Mar 2. PMID: 26931099.CrossRefPubMed

21.

Suzuki T, Kagami K, Mitani Y, Yamazaki R, Ono M, Fujiwara H. Twin anemia-polycythemia sequence with blood chimerism in monochorionic dizygotic opposite-sex twins. J Obstet Gynaecol Res. 2019;45(6):1201–4. https://doi.org/10.1111/jog.13949. Epub 2019 Feb 28. PMID: 30821075.CrossRefPubMed

22.

Souter VL, Kapur RP, Nyholt DR, Skogerboe K, Myerson D, Ton CC, Opheim KE, Easterling TR, Shields LE, Montgomery GW, Glass IA. A report of dizygous monochorionic twins. N Engl J Med. 2003;349(2):154–8. https://doi.org/10.1056/NEJMoa030050. PMID: 12853588.CrossRefPubMed

23.

Dyban AP, De Sutter P, Dozortsev D, Verlinsky Y. Visualization of second polar body chromosomes in fertilized and artificially activated mouse oocytes treated with okadaic acid. J Assist Reprod Genet. 1992;9(6):572–9. https://doi.org/10.1007/BF01204256. PMID: 1299391.CrossRefPubMed

24.

Walter A, Strizek B, Berg C, Geipel A, Gembruch U, Engels AC. Outcome of monochorionic twins with prenatally diagnosed bipartite placenta. Arch Gynecol Obstet. 2020;302(6):1549–52. https://doi.org/10.1007/s00404-019-05364-w. Epub 2019 Nov 25. PMID: 31768742.CrossRefPubMed

25.

Bogdanova N, Siebers U, Kelsch R, Markoff A, Röpke A, Exeler R, Tsokas J, Wieacker P. Blood chimerism in a girl with Down syndrome and possible freemartin effect leading to aplasia of the Müllerian derivatives. Hum Reprod. 2010;25(5):1339–43. https://doi.org/10.1093/humrep/deq048. Epub 2010 Feb 26. PMID: 20190264.CrossRefPubMed

26.

Peters HE, Johnson BN, Ehli EA, Micha D, Verhoeven MO, Davies GE, Dekker JJML, Overbeek A, Berg MHVD, Dulmen-den Broeder EV, Leeuwen FEV, Mijatovic V, Boomsma DI, Lambalk CB. Low prevalence of male microchimerism in women with Mayer-Rokitansky-Küster-Hauser syndrome. Hum Reprod. 2019;34(6):1117–25. https://doi.org/10.1093/humrep/dez044. PMID:31111890; PMCID:PMC6554047.CrossRefPubMedPubMedCentral

27.

Mysore KR, Shneider BL, Harpavat S. Biliary Atresia as a Disease Starting In Utero: Implications for Treatment, Diagnosis, and Pathogenesis. J Pediatr Gastroenterol Nutr. 2019;69(4):396–403. https://doi.org/10.1097/MPG.0000000000002450. PMID:31335837; PMCID:PMC6942669.CrossRefPubMedPubMedCentral

28.

Davenport M, Muntean A, Hadzic N. Biliary Atresia: Clinical Phenotypes and Aetiological Heterogeneity. J Clin Med. 2021;10(23):5675. https://doi.org/10.3390/jcm10235675. PMID:34884377; PMCID:PMC8658215.CrossRefPubMedPubMedCentral

29.

Xu X, Zhan J. Biliary atresia in twins: a systematic review and meta-analysis. Pediatr Surg Int. 2020;36(8):953–8. https://doi.org/10.1007/s00383-020-04690-4. Epub 2020 Jun 5. PMID: 32504124.CrossRefPubMed

Title: Rare spontaneous monochorionic dizygotic twins: a case report and a systematic review
Authors: Giulia Trombetta
Dora Fabbro
Eliana Demori
Lorenza Driul
Giuseppe Damante
Serena Xodo
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Twin-to-Twin Transfusion Syndrome
Published in: BMC Pregnancy and Childbirth / Issue 1/2022
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-022-04866-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Rare spontaneous monochorionic dizygotic twins: a case report and a systematic review

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda

Determinants of place birth: a multinomial logistic regression and spatial analysis of the Ethiopian mini demographic and health survey data, 2019

Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: analysis of 2019 mini demographic and health survey

Causes of perinatal mortality and associated maternal factors in a tertiary referral hospital of Gandaki province of Nepal: a cross-sectional study from a hospital-based surveillance

Weight gain rate in the second and third trimesters and fetal growth in women with gestational diabetes mellitus: a retrospective cohort study

Associations of severe adverse perinatal outcomes among continuous birth weight percentiles on different birth weight charts: a secondary analysis of a cluster randomized trial