Fetoscopic demonstration of perimortem feto–fetal hemorrhage in twin–twin transfusion syndrome

Quintero, Rubén A.; Martı́nez, J.; Bermúdez, Carlos; López, José Manuel López; Becerra, Carlos

doi:10.1046/j.1469-0705.2002.00859.x

Cited by 25 publications

(12 citation statements)

References 6 publications

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“…Recently, perimortem fetofetal blood transfusion and subsequent severe anemia in a surviving fetus around the time of single intrauterine death of co-twin have been considered to be a possible mechanism for the undesirable prognosis of the surviving fetus, which is called feto-fetal hemorrhage [3] . This assumption has been confirmed by fetal blood sampling [4,5] and by fetoscopic observation [6] . In fact, recent reports have shown that intrauterine rescue transfusion is useful to improve the prenatal outcome of the surviving fetus [5,7] .…”

Section: Introductionmentioning

confidence: 53%

“…Recently, fetal anemia caused by feto-fetal blood transfusion from surviving fetus to the dead fetus through placental vessels, which is called feto-fetal hemorrhage, has been recognized to be a cause for poor prognosis of the surviving fetus. In fact, anemia in the surviving fetus has been documented by a fetal blood sampling [4,5] or a fetoscopic observation [6] in several cases. Moreover, Okamura et al [12] reported that abnormal coagulation status was not shown in the surviving fetus by fetal blood sampling.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Monochorionic Twin Pregnancy Complicated with Intrauterine Single Fetal Death with Successful Treatment of Intrauterine Blood Transfusion in the Surviving Fetus

et al. 2006

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We report a case of monochorionic twin pregnancy complicated with single fetal demise that received successful treatment of intrauterine transfusion for severe anemia of the surviving fetus. A single fetal demise occurred at 20 weeks of gestation and middle cerebral artery peak systolic velocity (MCA-PSV), a marker for fetal anemia, showed marked elevation in the surviving fetus. Fetal blood sampling was immediately done and severe fetal anemia (hemoglobin = 5.5 g/dl, hematocrit = 16.8%) was confirmed, and then intrauterine transfusion was performed. After transfusion, MCA-PSV rapidly decreased to the normal value and remained within normal range until delivery. A healthy 2,640 g male infant was delivered at 35 weeks of gestation without anemic status and no neurological problem was found at 1-year old. The present report supports that intrauterine rescue transfusion is a useful treatment to prevent the adverse outcome of surviving fetus in monochorionic twin pregnancy complicated with single fetal demise, and monitoring of MCA-PSV is also useful to assess anemic status of the surviving fetus.

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Section: Introductionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

A Case of Monochorionic Twin Pregnancy Complicated with Intrauterine Single Fetal Death with Successful Treatment of Intrauterine Blood Transfusion in the Surviving Fetus

et al. 2006

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“…At the beginning of the surgery, the fetoscope revealed that the donor fetus was dark red and without cardiac activity, while the surviving triplets A and C were extremely pale. These fi ndings, as Quintero et al [16] have described before, suggested that feto-fetal hemorrhage, i.e., exsanguination of triplet A and C into the dead triplet B through patent placental vascular anastomoses, was occurring. Feto-fetal hemorrhage is thought to be a major cause of fetal demise and neurological injury of the surviving comonochorionic fetus [13][14][15][16] .…”

Section: Discussionmentioning

confidence: 72%

“…We think that this treatment would bring about a better outcome even in monochorionic triplet cases, although it would present a considerable technical challenge. We present here a case of monochorionic triamniotic triplet pregnancy with FFTS, complicated by feto-fetal hemorrhage [13][14][15][16] subsequent to spontaneous demise of the donor fetus at the beginning of the laser surgery.…”

Section: Introductionmentioning

confidence: 99%

An Experience of Laser Surgery for Feto-Fetal Transfusion Syndrome Complicated with Unexpected Feto-Fetal Hemorrhage in a Case of Monochorionic Triamniotic Triplets

et al. 2006

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Feto-fetal transfusion syndrome (FFTS) in monochorionic triplets is a rare clinical entity which may share the principal adverse perinatal outcomes of twin-twin transfusion syndrome. Recently, favorable prognoses regarding morbidity and mortality in twins after selective laser photocoagulation of placental communicating vessels (SLPCV) have been described. But descriptions of this procedure in monochorionic triplet cases are limited. This is the case report of an experience of SLPCV applied to monochorionic triamniotic triplets with FFTS. Triplet A had polyhydramnios, while absent end-diastolic flow in the umbilical artery of triplet B, the triplet with anhydramnios, was persistent. Triplet C looked normal, vertical amniotic pocket and Doppler studies yielding normal results. At the beginning of the SLPCV procedure, feto-fetal hemorrhage, subsequent to the fetal death of the donor triplet, occurred. Both surviving cofetuses showed persistent bradycardia; and 1 fetus died while the other recovered from the fetal bradycardia. All vascular anastomoses between the 3 triplets could be identified and obliterated, requiring two trocars. Our fetoscopic observation revealed feto-fetal hemorrhage after demise of monochorionic triplet, which led to injury of other fetuses due to hypovolemia in an instant. In conclusion, SLPCV might be a valid option for FFTS in triplet cases, while further experience is required in order to evaluate the risks and benefits of this procedure in triplet cases.

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“…Paradoxical acute hemorrhage of the recipient into the dead donor has been previously reported in the literature [8] and death of the donor twin is likely to induce a decrease in placental resistance. This phenomenon, combined with decreased systolic blood flow due to the recipient's systolic flow impairment, could account for the unusual umbilical artery flow pattern observed, combining high diastolic peak velocity and low S/D ratio.…”

Section: Discussionmentioning

confidence: 99%

Recipient’s Vascular Doppler Pattern Immediately following Death of the Donor in a Case of Untreated Severe Twin-to-Twin Transfusion Syndrome

Loureiro

Cunha²,

Beires³

et al. 2008

Fetal Diagn Ther

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In a stage III twin-to-twin transfusion syndrome, death of the donor at 31 weeks was followed by unusual umbilical artery (UA) doppler findings in the recipient, with a high diastolic peak velocity and a low S/D ratio. Besides, middle cerebral artery waveforms could not be obtained in the recipient. The recipient was delivered by emergency cesarean section, weighed 1,230 g, was strikingly pale and had a cord hemoglobin concentration of 15 g/dl. Neonatal blood average pressure was of 29 mm Hg, immediately after delivery, and ranged from 33 to 43 mm Hg in the first 12 h of life. Neonatal heart function returned to normal on day 2. We hypothesize that death of the donor twin induced an acute decrease in placental resistance. This phenomenon, combined with decreased systolic blood flow due to the recipient’s systolic function impairment, could account for the umbilical artery flow pattern we observed. The acute decrease in volemia and the presence of systemic hypertension and cardiomyopathy may explain the inability to obtain middle cerebral artery doppler. This complex hemodynamic disturbance in the recipient may be responsible for morbidity unrelated to anemia in case of donor’s demise, as acute fetal distress.

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Fetoscopic demonstration of perimortem feto–fetal hemorrhage in twin–twin transfusion syndrome

Cited by 25 publications

References 6 publications

A Case of Monochorionic Twin Pregnancy Complicated with Intrauterine Single Fetal Death with Successful Treatment of Intrauterine Blood Transfusion in the Surviving Fetus

A Case of Monochorionic Twin Pregnancy Complicated with Intrauterine Single Fetal Death with Successful Treatment of Intrauterine Blood Transfusion in the Surviving Fetus

An Experience of Laser Surgery for Feto-Fetal Transfusion Syndrome Complicated with Unexpected Feto-Fetal Hemorrhage in a Case of Monochorionic Triamniotic Triplets

Recipient’s Vascular Doppler Pattern Immediately following Death of the Donor in a Case of Untreated Severe Twin-to-Twin Transfusion Syndrome

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