SEVERE PREECLAMPSIA COMBINED WITH INTRAHEPATIC CHOLESTASIS OF PREGNANCY IN MONOCHORIONOC MONOAMNIOTIC TWINS AFTER IVF: A CLINICAL OBSERVATION
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Abstract
The combination of severe preeclampsia (PE) and intrahepatic cholestasis of pregnancy (IHCP) in multiple pregnancies is considered one of the most unfavorable obstetric situations due to the combined maternal and perinatal risks. According to recent meta-analyses, IHCP increases the risk of developing PE by 2.6 times and is diagnosed 3-5 times more frequently in multiple pregnancies than in singleton pregnancies.
It is characterized by earlier manifestation and higher serum bile acid levels. This clinical case of a 27-year-old primigravida carrying monochorionic monoamniotic (MCMA) twins after her fourth attempt at IVF/ICSI/PICSI is presented. The pregnancy was complicated by severe preeclampsia and IHCP. Timely diagnosis, multidisciplinary management, and informed early delivery prevented maternal and perinatal losses. Intraoperatively, the fetuses were diagnosed with complex intertwining and multiple knots of the umbilical cords, a characteristic complication of MCMA twins; stage I twin-to-twin transfusion syndrome (TTTS) was confirmed.
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