Iatrogenic Monoamniotic Twin Gestation with Progressive Twin-Twin Transfusion Syndrome

Suzuki, Shunji; Ishikawa, Gen; Sawa, Rintaro; Yoneyama, Yoshio; Otsubo, Yasuo; Araki, Tsutomu

doi:10.1159/000020897

Cited by 24 publications

(12 citation statements)

References 8 publications

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“…We were able to find 10 articles reporting 17 cases of pseudo‐monoamniotic twins derived from MD twins and their perinatal mortality rate is thought to be equivalent to original monoamniotic twins 3–12 . Trauma or physical rupture by the fetuses have been entertained as possible etiological factors 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Pseudo‐monoamniotic twins have been reported previously and their perinatal mortality rate would be equivalent to that of original monoamniotic twins. Although pseudo‐monoamniotic twins were reported previously, they were all suspected prenatally by ultrasound and were detected by the macroscopic and pathological findings after birth 3–12 . Meanwhile, fetoscopic laser photocoagulation for placental communicating vessels (FLP) has recently emerged as a treatment option for twin–twin transfusion syndrome (TTTS), which is usually performed before 26 weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

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Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation

Yoshimura

Aiko

Inagaki

et al. 2009

J of Obstet and Gynaecol

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Spontaneous antepartum rupture of the dividing membrane occurring in monochorionic diamniotic twins (MD twin) is an extremely rare complication and difficult to diagnose prenatally. We present a case of pseudo-monoamniotic twins derived from an MD twin gestation, which was suspected by ultrasound and was confirmed by antepartum fetoscopy. A 28-year-old woman, gravida 1, para 1 at 24 weeks of gestation was referred because of suspected polyhydroamnios in an MD twin. Ultrasound suggested twin-twin transfusion syndrome stage III, spontaneous rupture of the dividing membranes and cord entanglement. Fetoscopic laser photocoagulation (FLP) was performed using the Nd:YAG laser on 12 placental vascular connections. Fetoscopy revealed the spontaneous rupture of the dividing membrane and cord entanglement. The remainder of the pregnancy was managed as a monoamniotic twin gestation. Elective cesarean section was performed at 32 weeks of gestation following antenatal steroids and concordantly grown healthy male infants were delivered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation

Yoshimura

Aiko

Inagaki

et al. 2009

J of Obstet and Gynaecol

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“…The lack of predictive value of MCA Dopplers is perplexing. MCA evaluation was reported by Suzuki et al 15 to be a useful method to assess differential diagnoses between selective growth restriction in monochorionic twins and TTTS. They found a lower pulsatility index in the case of selective growth‐restricted twins in comparison with normal or even higher impedance when TTTS was present.…”

Section: Discussionmentioning

confidence: 99%

The role of Doppler studies in predicting individual intrauterine fetal demise after laser therapy for twin–twin transfusion syndrome

Martínez¹,

Bermúdez²,

Becerra³

et al. 2003

Ultrasound in Obstet & Gyne

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“…Twenty-five pregnancies were available for analysis (table 3). Three cases (9,15,19) were from the literature [15][16][17]. Cases 2 [18], 16 [19] and 18 [11] were analyzed in detail elsewhere.…”

Section: Resultsmentioning

confidence: 99%

Discordant Fetal Growth Patterns in Monochorionic Twin Pregnancies Described by Simple Algebraic Relations

Umur

Gemert²,

Schaap³

et al. 2003

Fetal Diagn Ther

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Objective: To test whether twin-twin transfusion syndrome (TTTS) and non-TTTS cases that were suspect but not confirmatory for developing the syndrome (non-TTTS-with-symptoms) have discordant fetal growth patterns that correlate with our previously derived algebraic relations. Methods: In 25 monochorionic twin pregnancies, fetal growth was determined by standard ultrasonography. The difference between estimated fetal weights (dEFW) as well as the difference divided by the average of the two weights, the difference average ratio (DAR), were fitted to the predicted trends of discordant fetal growth for TTTS and non-TTTS pregnancies. The best fits were compared with the clinical data. Results: Out of 13 TTTS cases, dEFW analysis correctly correlated with 8 (62%) and DAR analysis correctly with 10 (77%). Out of 12 non-TTTS-with-symptoms cases, dEFW analysis correctly correlated with 7 (58%) and DAR analysis correctly with 9 (75%). If TTTS correlated best, dEFW analysis was correct in 8/12 (67%), and DAR analysis in 10/11 (91%) cases. If non-TTTS correlated best, dEFW analysis was correct in 7/9 (78%), and DAR analysis in 9/12 (75%). The likelihood ratios of TTTS and non-TTTS were 1.9 and 0.26, respectively, with dEFW analysis, and 9.2 and 0.31 with DAR analysis. Conclusion: The simple algebraic relations derived to identify trends of fetal discordant growth show evidence that clinical TTTS and non-TTTS manifestations are quantifiable. The relations may contribute to future risk stratification in monochorionic twin pregnancies, e.g., by prospectively distinguishing between cases that will develop TTTS and those that will not, despite presenting with symptoms.

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Iatrogenic Monoamniotic Twin Gestation with Progressive Twin-Twin Transfusion Syndrome

Cited by 24 publications

References 8 publications

Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation

Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation

The role of Doppler studies in predicting individual intrauterine fetal demise after laser therapy for twin–twin transfusion syndrome

Discordant Fetal Growth Patterns in Monochorionic Twin Pregnancies Described by Simple Algebraic Relations

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