Which twin pregnancy type carries the highest risk for complications?

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In twin pregnancies, the type that carries the highest risk for complications is the monozygotic, monochorionic/monoamniotic configuration. This is due to several factors inherent in this specific type of twin pregnancy.

Monozygotic twins arise from a single fertilized egg that splits into two embryos. When this splitting occurs very early, both embryos may share the same chorion and amniotic sac, resulting in a monochorionic/monoamniotic situation. This configuration increases the risk of complications such as cord entanglement and twin-to-twin transfusion syndrome (TTTS). Cord entanglement can restrict blood flow and oxygen to one or both fetuses, potentially leading to significant morbidity or mortality. Twin-to-twin transfusion syndrome involves an imbalance in blood flow between the twins, which can lead to one twin receiving too much blood and the other too little, creating significant health risks for both.

In contrast, the other types of twin pregnancies, such as monozygotic, dichorionic/diamniotic or dizygotic pregnancies, typically have more separate resources, reducing the risk of complications significantly. Each twin in these configurations generally has its own placenta and amniotic sac, leading to lower risks

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