Recurrence of twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser coagulation (FLC) of placental anastomoses is unfavorable complication. Multiparous woman 34 years old in TTTS stage 2 was performed FLC of 8 arteriovenous anastomoses of the placenta followed by amnioreduction of 1000 ml on the gestational age of 22 weeks and 2 days. At gestational age of 24 weeks 6 days was revealed a recurrence of the TTTS, with considerable polyhydramnion of recipient and anhydramnion of the donor, a repeated FLC of 5 residual placental anastomoses was performed and amnioreduction of 2000 ml at 25 weeks 1 day of gestation. On the fifth day was normalized the amount of amniotic fluid of both fetuses. At 32 weeks of gestation spontaneously was began the birth, the weights of newborns were 1560 and 1600 g, both had Apgar score 8/9. Respiratory therapy continued for 7 hours at the second newborn and for 13 hours at the first newborn girl after transferring to the ICU. The signs of the respiratory failure were not observed. There were no differences between complete blood counts. This clinical case confirms the possibility of effective correction of recurrence TTTS with the help of repeated FLC of placental anastomoses.
Multiple pregnancy care based only on knowledge of fetal number does not satisfy clinical practice any more. Appropriate clinical use of data obtained via skilled and timely ultrasound has been proven to be of great value for reduction of typical complication rate in multiple pregnancy for both fetus and mother. Ultrasonography plays a key role when intrauterine interventions during pregnancy are required. It can be successfully used for both precise prenatal diagnosis of numerous chromosomal and congenital diseases and antenatal treatment of multiple pregnancy-specific complications, so medical professionals should be well-trained and experienced. And it is impossible without everyday clinical work, gaining individual knowledge and skills and being informed on developments and achievements in the best world recognized perinatal centers.
Single intrauterine fetal demise (sIUFD) in multiple pregnancy occurs with frequency from 3.7 up to 6.8 % and is associated with an risk of premature birth, death of cotwin and high morbidity and mortality rates in newborns. The time of sIUFD and type of twin gestation would determine perinatal outcomes. The rate of prenatal death of the co-twin is different and depend on the type of multiple pregnancy, accounting 4 % for dichorionic and 12 % in monochorionic pregnancies. However, the correlation between the type of chorionicity, delivery time and the frequency of preterm delivery is not clearly established. The risk of neurological complications in newborns after sIUFD fluctuate significantly in case of the type of chorionicity and could achieve 18 % in monochorionic twins and only 1 % in dichorionic twins. The paper was discussed the main reasons for sIUFD in multiple pregnancy, rather pathophysiological aspects of perinatal morbidity and mortality for cotwin was also discussed. The management of complications, methods of their correction, optimal methods and time of delivery in case of sIUDF in multiple pregnancies was presented.
Twin anemia polycythemia sequence (TAPS) is a specific complication of the monochorionic multiple birth, which is based on chronic feto-fetal blood transfusion over placental vascular anastomoses, and the main clinical symptom is discordant fetal hemoglobin level in the absence amniotic fluid imbalance. Currently, there is no generally recognized consensus on the optimal treatment tactics. Dynamic observation, labor, intrauterine blood transfusion, selective fetocide, fetoscopic laser coagulation of placental vascular anastomoses are applied, although the latter is recognized by the majority of researchers as the most promising method for treating TAPS. There are disagreements in estimating the frequency of perinatal morbidity and mortality during pregnancy, complicated by the development of TAPS, and their real value has not yet been completely defined. Key words: intrauterine transfusion, Solomon method, monochorionic twins, twin anemia polycythemia sequence, fetoscopic laser coagulation
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