Management of Single Fetal Death in Twin-to-Twin Transfusion Syndrome: A Role for Fetal Blood Sampling

Senat, M. V.; Bernard, Jean‐Pierre; Loizeau, S.; Ville, Y.

doi:10.1097/01.ogx.0000058692.18516.fd

Cited by 11 publications

(15 citation statements)

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“…In TTTS-cases, however, the incidence of intrauterine fetal death (IUFD) is about 30% [16][17][18][19]. Because of vascular inter-twin connections in MC twins, there are substantial risks to the remaining twin including a 25% risk of ischemic brain injury and a comparable risk of immediate cotwin death [20,21]. In DC twin pregnancies, IUFD does not threaten the co-twin's condition.…”

Section: Intrauterine Fetal Deathmentioning

confidence: 97%

Ultrasound examination in twin pregnancies

Sueters

Oepkes

2005

International Congress Series

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Section: Intrauterine Fetal Deathmentioning

confidence: 97%

Ultrasound examination in twin pregnancies

Sueters

Oepkes

2005

International Congress Series

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“…Des taux similaires de séquelles cérébrales ont été décrits après la coagulation laser, respectivement 4,2 % [41] et 6 % [50]. En cas de mort in utero d'un des jumeaux, une anémie aiguë du survivant a été documentée par une étude récente [51] confortant la théorie d'une « transfusion aiguë » du jumeau survivant dans le secteur vasculaire du co-jumeau décédé [52]. Les résultats préliminaires en cours de publication de l'étude européenne « eurofetus » comparant amniodrainage et laser dans les formes graves diagnostiquées avant 26 semaines montrent clairement la supériorité de la photo-coagulation, à la fois en terme de mortalité périnatale et de risque de séquelles cérébrales.…”

Section: éValuation Du Risque Périnatal Traitementunclassified

Stratégies de diagnostic prénatal et prise en charge des pathologies liées aux grossesses multiples

Picone

Dommergues

2004

Gynécologie Obstétrique & Fertilité

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“…This small series suggests that cerebral lesions occur in those with anemia after co-twin demise and those without anemia appear to do well. It may also suggest that the outcome is potentially improved, with no mortality and observation of intact outcome at the one-year follow-up, in 2/3 of the cases with anemia [6].…”

mentioning

confidence: 96%

“…To our knowledge, there are only a few case series reporting intrauterine transfusion (IUT) for management of SIUFD in TTTS [6,7,9].…”

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confidence: 98%

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Use of middle cerebral artery peak systolic velocity and intrauterine transfusion for management of twin–twin transfusion and single fetal intrauterine demise

Özcan

Thornburg

Mingione

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

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A 42 year-old-woman, gravida 3 para 2, at 21 weeks and three days of gestation with monochorionic/ diamniotic twins was diagnosed with twin-to-twin transfusion syndrome (TTTS). There was oligopolyhydramnios sequence with maximum vertical pocket less than 2 cm for the donor twin and 8.5 cm for the recipient twin as well as a non-visible bladder for the donor twin. The patient was counseled regarding her options and decided to have amnioreduction. One thousand milliliters of fluid were removed with a maximum vertical pocket of 9.6 cm at the end of the procedure. Follow-up at two days revealed normal fluid volumes in both sacs and a large and small bladder for the recipient and the donor twin, respectively. There was absent end-diastolic flow in the umbilical artery of the recipient twin.The patient was referred for a consultation for possible laser surgery. Laser surgery was not deemed necessary by the consultants but they did recommend a follow-up of myocardial function, amniotic fluid volumes, and Doppler studies [1]. At 22 weeks and two days, the bladder, amniotic fluid volume, and Doppler waveforms of umbilical artery and ductus venosus and myocardial function studies for both twins appeared normal. At 23 weeks and two days interspersing of the amniotic membranes secondary to amnioreduction and absent enddiastolic flow in the umbilical artery of the donor twin were noted. At 24 weeks the middle cerebral artery (MCA) Doppler waveform for twin B revealed brain sparing with Doppler ratios below the 95th percentile and normal velocity.The patient presented with decreased fetal movement at 25 weeks and one day and demise of the recipient twin was noted. The middle cerebral artery peak systolic velocity (MCA PSV) was above the 1.55 multiples of the median (MoM) for the donor twin B (Figure 1a). There was skin edema and polyhydramnios. The patient was counseled regarding the risks and benefits of intrauterine transfusion (IUT) and desired to proceed with the procedure. The procedure was performed within 24 hours from the diagnosis of single intrauterine fetal demise (SIUFD). The opening hematocrit was 12%. The closing hematocrit was 43% after 75 mL of blood transfusion. The post-procedure MCA PSV was within normal limits ( Figure 1b).Pleural effusion with polyhydramnios was noted two days after the transfusion (Figure 2). Those signs resolved at 26 weeks. The patient was followed with biweekly nonstress testing and ultrasound examinations. Biweekly MCA PSV Doppler measurements remained within normal levels after the IUT procedure. The patient presented in active labor at 31 weeks and delivered a 1940 g male infant with Apgar scores of 8

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Management of Single Fetal Death in Twin-to-Twin Transfusion Syndrome: A Role for Fetal Blood Sampling

Cited by 11 publications

References 0 publications

Ultrasound examination in twin pregnancies

Ultrasound examination in twin pregnancies

Stratégies de diagnostic prénatal et prise en charge des pathologies liées aux grossesses multiples

Use of middle cerebral artery peak systolic velocity and intrauterine transfusion for management of twin–twin transfusion and single fetal intrauterine demise

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