Single twin demise in the context of multiple pregnancy is rare but with severe consequences for the other twin. This event is more common in the first trimester and is clinically called vanishing twin; it may affect the normal development of the other twin. Understanding the complexity of vascular anastomosis in monochorionic gestation has helped to elucidate the pathophysiology of fetal death and brain damage, explained by exchange transfusion from one twin to the other, and determining the probability of death of the surviving fetus and neurological damage related to gestational age of occurrence, premature birth and monochorionicity. These cases require individual monitoring of the surviving fetus, neurosonography and magnetic resonance imaging.

Chorio-angiopagus twins (fetuses sharing one placenta) may exclusively show asymmetry in the distribution of placental territories with high incidence of marginal insertion and sometimes velamentous placenta as well as twin-twin transfusion (acute or chronic) produced by vessel communications (placental anastomosis). A series of fetal phenotypes may result including twin-to-twin transfusion syndrome, selective intrauterine growth restriction, anemia-polycythemia syndrome, and twin reversed arterial perfusion – TRAP- sequence; they may coexist. It is therefore important to study placental angioarchitecture in monochorionic twins in order to understand resulting both outcome and phenotype.

Fetal growth restriction is intimately linked to the placental function due to its failure of adequately nurture and oxygenate the fetus, with consequences in the short and long term. The search for the best definition and best diagnostic biomarkers has currently led to angiogenic factors closely related to the placenta formation and development. Placenta hypoperfusion has been linked to alterations in the levels of angiogenic factors, and it is proposed that these could help to differentiate the fetuses truly affected by chronic hypoxia even before the late adaptive hemodynamic changes are evident by Doppler ultrasound. This could have implications not only in the definition of growth restriction but also in the potential prediction of the event.

La restricción de crecimiento fetal está íntimamente ligada a la función placentaria por el fracaso de la adecuada nutrición y oxigenación del feto, con múltiples consecuencias a corto y largo plazo. La búsqueda de la mejor definición y de los mejores biomarcadores diagnósticos actualmente se dirige a los factores angiogénicos. Estos factores se relacionan estrechamente con la formación y desarrollo placentario. En la hipoperfusión placentaria se ha hallado alteraciones en los niveles de los factores angiogénicos, por lo que estos factores podrían ayudar a diferenciar a los fetos verdaderamente afectados por hipoxia crónica aún antes que los cambios hemodinámicos adaptativos tardíos sean evidenciables en la ultrasonografía Doppler. Esto podría tener implicancias no solo en la definición de restricción de crecimiento sino también en la potencial predicción del eve...

La preeclampsia es la enfermedad más enigmática de la medicina fetal, recientes descubrimientos nos acercan a poder completar la compleja cascada fisiopatológica de la disfunción endotelial materna en preeclampsia. Los factores angiogénicos y el desequilibrio producido por el aumento de la producción placentaria de factores antiangiogénicos se constituyen como una sólida teoría para unificar la disfunción endotelial materna y la hipoperfusión placentaria.

Multiple gestation pregnancy rates have increased in recent years possibly related to socio-demographic factors including deferral of motherhood and some medical factors like fertility treatments. Associated complications including prematurity, cerebral palsy, hypertensive disease of pregnancy, hyperemesis, gestational diabetes have also increased.

We present the clinical case of a fetus with the diagnosis of cervical lymphangioma and review the updated literature on development embryopathy and the management of this entity. It was developed in the Fetal Medicine Unit of the High Risk Gynecology and Obstetrics Service of the Guillermo Almenara Irigoyen EsSalud National Hospital, Lima, Peru. We documented the case of a fetus with the diagnosis of cervical lymphangioma evaluated prenatally and successfully managed using the EXIT procedure. Embryology knowledge of the development and prenatal diagnosis of cervical lymphangiomas are of clinical importance in fetal management and prognosis.