ON rare occasions, when unlovular twins 1 rare occastons, when uniovular twins are born one may be found to be polycythemic and the other anemic. The cause is intrauterine transplacental transfusion; the blood of one twin has been shunted into the circulation of the second twin through arteriovenous anastomoses within the placenta.
Case DescriptionA 22-year-old, para 1 and gravida 1 white mother had gained 50 Ib. during pregnancy. One week before delivery she became pre-eciamptic with dependent edema, proteinuria, and a blood pressure of 140/90. Her blood type was 0, Rh positive and her blood hemoglobin level was 9.8 Gm, Birth Female twins were delivered spontaneously at 37V2 weeks' gestation. Twin A had a vertex presentation and weighed 5 lb. 12 oz.; polyhydramnios (over 1,000 ml.) was noted. Twin B was a breech extraction; birth weight was 4 lb. 4 oz.; and oligohydramnios was present. The umbilical cords appeared normal. The placenta was monochorionic and diamniotic with no obvious hemorrhages or infarctions.The first twin (A) was plethoric, cyanotic, dark bronze in colour, and in moderate respiratory distress with dyspnea and grunting respiration. Her heart sounds were good, and liver and spleen not enlarged. She was placed in an oxygen unit. Twin I (B) was pale, apathetic and listless but had no signs of respiratory distress, cyanosis or shock.Hematologic data three hours after birth were as follows: Table 1 shows subsequent hematologic changes in these twins. The white and differential counts of both were always normal.
Clinical CourseTwin A: Heart and lungs were normal on radiologic examination and her respiratory distress subsided within 48 hours. On the second day of life 15 ml. of blood were withdrawn from the femoral vein. It had been p!anned to remove more but the blood was so viscous it clotted immediately in the syringe. Jaundice developed on the third day of life; the serum bilirubin level rose to 17.3 mg. per cent, total 14.3 indirect and 3.0 direct, and then subsided gradually during the next four days. The . baby was discharged on the seventh day of life, appearing well and with no signs of respiratory distress or cardiac overload. The hemoglobin level remained at 22 Gm., the hematocrit was 75 per cent.at Kungl Tekniska Hogskolan / Royal Institute of Technology on August 25, 2015 cpj.sagepub.com Downloaded from