Diagnosis and Treatment of Twin to Twin Transfusion in the Mid-Second Trimester of Pregnancy

Weiner, Carl P.

doi:10.1159/000263286

Cited by 34 publications

(11 citation statements)

References 7 publications

(10 reference statements)

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“…These approaches include conserva tive management, serial amniocentesis [4,12,13], laser coagulation of placental anastomo sis [14], and selective feticide [15,16].…”

Section: Commentmentioning

confidence: 99%

Twin-to-Twin Transfusion Syndrome: Selective Feticide by Embolization of the Hydropic Fetus

et al. 1995

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To improve the outcome of severe twin-to-twin transfusion syndrome with 1 hydropic fetus and to prevent ischemic sequelae in the survivor, we developed a technique of selective feticide by vascular embolization of the most severely damaged twin. Acute second trimester polyhydramnios occurred in 4 biamniotic monochorial twin pregnancies, with 1 fetus normal on ultrasound but the other severely damaged by hydrops and hypertrophic hypokinetic cardiomyopathy. The hydropic fetus underwent embolization using a bolus of histoacryl injected into the umbilical vein and fetal heart under ultrasound guidance. In 1 triplet pregnancy with a set of monochorial fetuses, premature labor occurred at 26 weeks, 2 weeks after embolization, and there were 2 neonatal deaths. The 3 other cases resulted in the birth of a normal infant at 31–37 weeks of gestation. This suggests that in twin-to-twin transfusion syndrome with severe polyhydramnios and hydrops of 1 fetus, embolization may salvage the other twin.

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“…These approaches include conserva tive management, serial amniocentesis [4,12,13], laser coagulation of placental anastomo sis [14], and selective feticide [15,16].…”

Section: Commentmentioning

confidence: 99%

Twin-to-Twin Transfusion Syndrome: Selective Feticide by Embolization of the Hydropic Fetus

et al. 1995

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“…Subsequently, Baldwin and Wittmann ( 1990 ) summarized their favorable experience with this procedure in three cases of the transfusion syndrome. Weiner ( 1987 ) had earlier reported a similar experience. In the days that long preceded sonography, we had unsuccessfully attempted a similar procedure (Benirschke and Driscoll 1967 ) .…”

Section: Twin-to-twin Transfusion Syndromementioning

confidence: 64%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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“…Three wom en chose selective fetocide. In each instance, the donor twin was killed as previously de scribed [16].…”

Section: Therapymentioning

confidence: 99%

Diagnosis, Pathophysiology, and Treatment of Chronic Twin-to-Twin Transfusion Syndrome

Weiner

Ludomirski

1994

Fetal Diagn Ther

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The discovery of a ‘stuck twin’ during an ultrasound examination has often been equated with twin-to-twin transfusion based to a great extent on postnatal confirmation of discordant fetal size and hemoglobin concentration. However, the diagnosis of twin-to-twin transfusion cannot be made with certainty after birth since virtually all monochorionic gestations have placental anastomoses and there are many causes of growth deficiency and abnormal hemoglobin concentration. The purpose of this study is to investigate the pathophysiology of chronic twin-to-twin transfusion syndrome and apply the findings to the development of a anagement algorithm. In 42 twin gestations with stuck twin associated with acute hydramnios, we performed targeted ultrasound cordocentesis in each fetus and therapeutic amniocentesis. The diagnosis of chronic twin-to-twin transfusion syndrome required: sonographic evidence of monochorionicity; rapid reaccumulation of fluid after amniocentesis; discordant fetal size, and divergent fetal hematocrit measurements with at least one above or below the 95% confidence interval for gestational age. These criteria were met in 20 of 42 (48%) pregnancies. The mean gestation was 23.8 ± 2 weeks (range 21-27 weeks). In 4 pregnancies, the transfer of adult RBCs from the donor to the recipient was documented. Monochorionicity was confirmed in all postnatally. All recipients had polycythemia and hyperproteinemia. Hydrops developed only in the recipient twin (6 of 20) and was associated with an elevated umbilical venous pressure. All pregnancies were treated with aggressive serial therapeutic amniocenteses. There was no objective evidence that amniocentesis altered the magnitude of the shunt. In addition, 1 patient chose pregnancy termination, 3 a selective fetocide of the donor twin, and 4 transfusion therapy. The mean gestation at delivery was 29 + 4 weeks and the perinatal mortality rate 58% (23 of 40 fetuses). Survival was significantly lower when symptoms appeared < 25 weeks (10 of 30 vs. 7 of 10, p = 0.04). The presumptive diagnosis of twin-to-twin transfusion is frequently erroneous and an accurate diagnosis required antenatal evaluation. Hydrops results from heart failure secondary to a combination of polycythemia and hyperproteinemia. Because no antenatal therapy is clearly effective and the likelihood of neonatal survival is greater when symptoms first appear ≥ 24 weeks, an invasive evaluation should be limited to those pregnancies which either present < 25 or ≥ 25 weeks with a hydropic fetus.

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Diagnosis and Treatment of Twin to Twin Transfusion in the Mid-Second Trimester of Pregnancy

Cited by 34 publications

References 7 publications

Twin-to-Twin Transfusion Syndrome: Selective Feticide by Embolization of the Hydropic Fetus

Twin-to-Twin Transfusion Syndrome: Selective Feticide by Embolization of the Hydropic Fetus

Multiple Pregnancies

Diagnosis, Pathophysiology, and Treatment of Chronic Twin-to-Twin Transfusion Syndrome

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