Funipuncture for Evaluation of Hematologic and Coagulation Indices in the Surviving Twin Following Co-Twinʼs Death

Abstract

Following the death of one twin, morbidity in the surviving twin can be produced by hypotensive ischemia of the brain due to hemorrhage through placental vascular anastomoses.

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto‐fetal transfusion syndrome

“…15 Single IUFD involved 11 donors and 8 recipients. The median gestational age at IUD was 23 [20][21][22][23][24][25][26][27][28] weeks, and the median interval between IUFD and intrauterine transfusion (IUT) was 12 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] hours. The median volume of blood transfused was 40 ml.…”

“…17 These complications are mainly due to acute and profound exsanguination of the live fetus into its dead co-twin and its placenta across placental vascular anastomoses at around the time of death. [5][6][7][8] The consequences of the death of one MC twin are probably related to angioarchitectural features of the MC placenta. Around 15% of MC pregnancies develop FFTS; 18 however, the exsanguination phenomenon can also develop in the absence of FFTS.…”

“…It is now well established that increased mortality and morbidity of the survivors are related to acute exsanguinations into the dead fetus and its placenta at around the time of death. [6][7][8][9] Denbow et al 10 and Taylor et al 11 have demonstrated that the outcome of MC pregnancies as well as When the diagnosis of single IUD is made in an MC pregnancy, one should seek ultrasound and Doppler features of fetal anaemia. 10 Acute and profound anaemia can cause death or ischemia of several organs such as brain, liver, bowel, kidneys and limbs related to low blood flow.…”

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

“…The mechanism of injury to the second twin after demise of the first is believed to be mediated via perimortem feto-fetal hemorrhage through patent placental vascular anastomoses. This has been documented through serial cordocentesis in a surviving twin after demise of the other fetus 1 . We present endoscopic evidence of feto-fetal hemorrhage from recipient to donor after spontaneous demise of a donor twin.…”

“…Such a mechanism has never been documented. In contrast, fetal anemia resulting from perimortem feto-fetal hemorrhage from the surviving to the dead twin through placental vessels has been documented in several cases 1,5 . Paradoxical anemia in the recipient twin and polycythemia in the donor twin, as in our case, can be explained by such a mechanism when the donor twin dies first.…”