A case of triplets including anomalous twins and a fetus compressus

Roos, Frederick J.; Roter, Alexander M.; Molina, Francisco A.

doi:10.1016/0002-9378(57)90280-6

Cited by 17 publications

(5 citation statements)

References 8 publications

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“…They may be of monochorionic or dichorionic gestations; congenital anomalies other than acardia have been occasionally identi fi ed on dissection. The co-twin of a fetus papyraceus may also have anomalies, such as microcephaly, absent ear (Roos et al 1957 ) , gastroschisis (Weiss et al 1976 ) , ileal atresia (Saier et al 1975 ) , or pulmonic stenosis (Baker and Doering 1982 ; review by Szymonowicz et al 1986 ) . In a discussion of a case of ileal atresia, Sander ( 1983 ) drew attention to the possible cause of these anomalies.…”

Section: Fetus Papyraceusmentioning

confidence: 99%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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Section: Fetus Papyraceusmentioning

confidence: 99%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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“…Using computerized and conventional literature searching, we located 38 previously reported cases of monochorionic or presumed monochorionic twins with fetal demise of one twin and structural defects of the living twin (twin embolization syndrome) that included case history information, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In 38 of the 41 cases, an estimate of the timing of the fetal demise could be made based on the size or weight of the dead twin. The major defects detected in the 41 cases are summarized in Table 1 Sonograms were performed at a time when findings of TES could be expected in 15 of the 41 cases.…”

Section: Previously Reported Casesmentioning

confidence: 99%

“…SUMMARY OF FINDINGSOf the 31 cases for which placental information was available, 3 cases were monochorionic-monoamniotic5,15,18 and 29 cases were monochorionic-diamniotic.1,3,H,[10][11][12][13][14]16,17 In only 25 of 41…”

mentioning

confidence: 99%

Sonographic Evaluation of Twin Embolization Syndrome

Gray¹,

Rouse

Lange

1993

Journal of Diagnostic Medical Sonography

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Twin embolization syndrome (TES) is a rare complication of twin-twin transfusion after intrauterine demise of one of a pair of twins sharing the same placenta. In such cases, infarcts in the surviving co-twin can cause structural and functional changes, presumably due to embolization of debris, thrombus, thromboplastic material, and toxins from the dying twin's circulation into the circulation of the other twin. Sonographic, clinical, and pathologic findings in 3 new cases are reported, and 38 previously reported cases of TES are reviewed.Of the 41 cases, 34 (83%) had evidence of a destructive structural brain defect. In the 34 cases with brain defects, 23 (68%) had intracranial cystic changes. Microcephaly had developed in the surviving twin by the time of delivery in 7 (41%) of the 17 cases with brain defects and evidence of twin fetal demise before 22 weeks. Intestinal atresia was noted in 4 of 41 cases (10%), and renal dysplasia or renal cortical necrosis was observed in 11 cases (27%). In cases of intrauterine demise of a monochorionic twin, careful follow-up evaluation of the surviving twin should be performed.

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“…An excess of structural defects of the cer ebrum and/or viscera has been described in monozygotic twins compared to dizygotic twins or singletons [2,28,41,50]. Schinzel et al [55] and Schinzel [54] reported an exam ple of facio-auriculovertebral complex in the surviving twin of a fetus papyraceus and concluded that the defect might have been caused by embolization of thrombotic tissue or necrotic tissue from the deceased twin or its placenta into a neck artery of the surviv ing twin.…”

Section: Cerebral Malformationsmentioning

confidence: 99%

“…The frequency of antepartum death of one twin varies, in the literature, from 0.5 to 6.8% [21,22,39,44]; the incidence of fetofetal transfusion with death of a fetus and damage in the survivor is not known. Depend ing on the time elapsed between death and delivery the fetus is macerated or papyraceus [10,15,36,44,47] or fetus compressus [50]. In this situation, hypoxic-ischemic lesions are expected to be found in the donor twin.…”

Section: Etiopathogenymentioning

confidence: 99%

Brain Damage in Monozygous Twins

Droullé²,

et al. 1990

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A series of 15 monochorionic twins with a great variety of cerebral lesions is reported. Seven cases illustrate the classical situation: the recipient twin was affected and his co-twin, the donor was macerated. In 5 cases, the lesions were described in the donor twin as well and once, as early as 22 weeks. The lesions were usually hypoxic-ischemic, in 2 they were hemorrhagic. In 1 case there was a malformation. Fetal US were performed in 11 cases and the diagnosis of either IUGR, death of a fetus and/or brain lesions in the survivor could be made in 10 cases and once as early as 21 weeks. In fetuses born alive, transfontanellar US or CT scan have confirmed the diagnosis made on fetal US. The pathogenesis of the lesions is not fully understood. Lesions in the recipient twin may result from emboli or thromboplastic material originating from the macerated co-twin. We suggest that blood pressure instability or episodes of severe hypotension might as well lead to brain and/or visceral lesions in the recipient twin. In the donor, the lesions result from hypotension and/or anemia. With improvement and generalization of imaging techniques, the vitality of the fetuses as well as biometric parameters and anatomical structures will be better controlled. However, in case of a fetal death, occurrence of lesions in the survivor is unpredictable and no uniform policy has been proposed yet. Studies with Doppler and continuous monitoring of funicular circulation should improve our knowledge on feto-fetal transfusion and permit to detect hemodynamic fluctuation or impairment.

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A case of triplets including anomalous twins and a fetus compressus

Cited by 17 publications

References 8 publications

Multiple Pregnancies

Multiple Pregnancies

Sonographic Evaluation of Twin Embolization Syndrome

Brain Damage in Monozygous Twins

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