Non‐invasive diagnosis by Doppler ultrasonography of fetal anemia due to massive fetomaternal hemorrhage in a case of twin–twin transfusion syndrome treated with serial amnioreduction

Cosmi, Erich; Litta, Pietro; Andrisani, Alessandra; Lenardo, L. Di; Fadda, Gm; Ambrosini, Guido

doi:10.1002/uog.1830

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…In that sense, MCA-PSV can serve as a highly sensitive screening tool to restrict fetal blood sampling to the few pregnancies at very high risk of severe anemia for confirmation and possible treatment purposes. Similar results regarding the role of MCA-PSV in the noninvasive diagnosis of fetal anemia have been presented in cases of parvovirus infection [11], and in fetomaternal hemorrhage in twin-to-twin transfusion syndrome [12].…”

Section: Discussionmentioning

confidence: 51%

Increasing the noninvasive management of rhesus isoimmunization

Papantoniou¹,

Anastasakis²,

Marinopoulos³

et al. 2008

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 51%

Increasing the noninvasive management of rhesus isoimmunization

Papantoniou¹,

Anastasakis²,

Marinopoulos³

et al. 2008

Intl J Gynecology & Obste

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“…Amnioreduction is more readily and easily available throughout the world, but is only a symptomatic treatment. It is also associated with invasive procedure-related complications including rupture of the membranes but also massive feto-maternal hemorrhage [8]. In addition, as shown in this case report, amnioreduction in TTTS may lead to sudden changes in intrauterine pressure and blood flow through anastomoses.…”

Section: Discussionmentioning

confidence: 99%

Sudden Fetal Hematologic Changes as a Complication of Amnioreduction in Twin-Twin Transfusion Syndrome

et al. 2018

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We present the first case of a monochorionic twin pregnancy in which sudden hematologic changes occurred as a complication of the amnioreduction procedure for twin-twin transfusion syndrome (TTTS). At 33 weeks of gestation, 4 days after the amnioreduction, the recipient developed severe anemia while the donor developed severe polycythemia. Postnatal placental examination revealed several arteriovenous and venoarterial anastomoses, a pale placental mass of the recipient and a congested and plethoric placental mass of the donor. We speculate on the pathophysiologic changes and potential deleterious effects provoked by the decompressive amnioreduction. Decompression of the placenta and anastomoses after the amnioreduction may have led to an acute blood shift from recipient to donor (thus also a reversal of feto-fetal transfusion), resulting in anemia in the recipient and polycythemia in the donor twin. In the past 15 years, 13 TTTS cases with late presentation were treated with amnioreduction. This is the first time we encountered this severe complication, yielding an incidence of 8%. Although the optimal treatment in TTTS with late presentation is not known, perinatologists should be aware that treatment with amnioreduction can lead to sudden hematologic changes.

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“…Doppler assessment of the MCA-PSV has been exhaustively studied in the noninvasive diagnosis of fetal anemia in maternal red cell alloimmunization and in nonimmune hydrops fetalis due to parvovirus B19 infections [9,[18][19][20] . Moreover, Doppler investigation of the MCA-PSV is also a useful tool to predict fetal anemia due to FMH.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of a Severe Second Trimester Fetomaternal Hemorrhage by Repeated Fetal Intravascular Transfusions

et al. 2008

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Objective: It was the aim of this study to report a case of fetomaternal hemorrhage (FMH) that was successfully treated with fetal intravascular transfusions in which the middle cerebral artery peak systolic velocity (MCA-PSV) detected fetal anemia. Methods: A massive FMH occurred twice in a healthy 33-year-old pregnant woman at 26 and 29 weeks of gestation with no evident cause. Four repeated intravascular transfusions were performed. The MCA-PSV increased in the presence of anemia and decreased following correction of fetal hematocrit. Results: A healthy neonate was delivered at 33 weeks of gestation. Conclusion: MCA-PSV detected fetal anemia both before the first transfusion and following the next intravascular transfusions. In our case, the change in fetal blood viscosity following transfusion with adult blood did not affect the MCA-PSV value for detection of fetal anemia.

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Non‐invasive diagnosis by Doppler ultrasonography of fetal anemia due to massive fetomaternal hemorrhage in a case of twin–twin transfusion syndrome treated with serial amnioreduction

Cited by 9 publications

References 8 publications

Increasing the noninvasive management of rhesus isoimmunization

Increasing the noninvasive management of rhesus isoimmunization

Sudden Fetal Hematologic Changes as a Complication of Amnioreduction in Twin-Twin Transfusion Syndrome

Successful Treatment of a Severe Second Trimester Fetomaternal Hemorrhage by Repeated Fetal Intravascular Transfusions

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