Multicystic encephalomalacia and gastrointestinal injury following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy: a case report

Abstract

Background Monochorionic multifetal pregnancies are at increased risk of adverse perinatal outcome because of placental vascular anastomoses. We present a case of multicystic encephalomalacia and gastrointestinal injury in two surviving fetuses following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy. Case presentation A 31-year-old nulliparous woman had a spontaneous monochorionic triamniotic triplet pregnancy. Three live fetuses with single placenta were seen at 8-week ultrasound scan. One fetus demised at 11 weeks and 3 days of gestation. Dilated echogenic bowel and ascites were found in one surviving fetus at 23 weeks of gestation. At 28 weeks of gestation, the pregnancy was complicated by fetofetal transfusion syndrome in which discordant amniotic fluid volumes were found. Two days later, emergency Caesarean section was performed because of worsening of fetal Doppler and biophysical profile. One baby was found to have jejunal atresia requiring surgery at 4 days old. He had periventricular leukomalacia and intracranial haemorrhage, but subsequent normal neurological development. Another baby had gastric perforation requiring surgery at 2 days old. He was confirmed to have multicystic encephalomalacia by cranial ultrasound and magnetic resonance imaging. He suffered from developmental delay, epilepsy and cerebral palsy. Conclusion This case alerts the obstetricians the possible hypoxic-ischemic injury to the survivors of monochorionic triplet pregnancy after the co-triplet death in the first trimester and fetofetal transfusion syndrome. Antenatal assessment and postnatal follow-up are important for these high-risk multiple pregnancies.

Intertwin nuchal translucency difference predicts the chance of co-twin death after fetal reduction in dichorionic triplet pregnancies: a retrospective analysis study

“…One small study with 9 MC twin pregnancies in which sIUFD occurred as a complication between the 5 th and 11 th gestational week (mean, 7.4 weeks) reported poor prognoses for the co-twin [ 28 ]. There have also been case reports of severe neurological injury of the co-twin after sIUFD in the first trimester in an MC twin pregnancy [ 29 ] and an MC triplet pregnancy [ 30 ]. In our study, potassium chloride injection into one of the MC twins, a situation similar to sIUFD, was also performed mainly in early pregnancy, and co-twin death occurred within 1 week in most cases, suggesting that there may be abundant communicating vessels in early MC twin pregnancies.…”

Spontaneous Monochorionic Triamniotic Triplet Pregnancy: A Case Report

“…To the best of our knowledge, seven reported cases of spontaneously conceived MCTA triplet pregnancy were associated with complications such as feto-fetal transfusion syndrome, congenital anomalies, or acardiac fetuses [4] [5] [6] [7].…”