Renal Failure after Single Fetal Demise in Monochorionic Twins: Incidence and Description of a Case

Genova, Lorenza Di; Sueters, Marieke; Oepkes, Dick; Steggerda, Sylke J.; Lopriore, Enrico

doi:10.1159/000354344

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…Perinatal asphyxia was detected in six (13%) neonates and three (6%) were diagnosed with persistent pulmonary hypertension, of which one required extracorporeal membrane oxygenation. This child was diagnosed with severe renal failure and died at 2 years of age after a renal transplant. Eight (17%) neonates were treated with blood transfusion, of which five also required inotropic medication at birth.…”

Section: Resultsmentioning

confidence: 99%

Single fetal demise in monochorionic pregnancies: incidence and patterns of cerebral injury

Klink

Steenis

Steggerda

et al. 2015

Ultrasound in Obstet & Gyne

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Section: Resultsmentioning

confidence: 99%

Single fetal demise in monochorionic pregnancies: incidence and patterns of cerebral injury

Klink

Steenis

Steggerda

et al. 2015

Ultrasound in Obstet & Gyne

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“…1,2 Bowel and renal complications have also been reported. 3,4 The present case illustrates successful intervention with a combination of interstitial laser to a placental anastomosis and intracardiac transfusion for a fetus at 15 weeks of gestation following monochorionic co-twin demise. The risk of co-twin demise and neonatal death is increased significantly in cases of single intrauterine fetal death in monochorionic pregnancies before 28 weeks.…”

Section: Discussionmentioning

confidence: 92%

Combined interstitial laser cauterisation of placental anastomosis and intrauterine intracardiac transfusion following monochorionic co-twin demise: a case report

2021

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Single fetal demise in monochorionic pregnancy is associated with significant morbidity and mortality of the co-twin. We report the case of a 36-year-old nulliparous woman with unexpected single fetal demise in a monochorionic twin pregnancy diagnosed at 15 weeks and 4 days. She had been well since her last normal scan at 13 weeks and 3 days and no discordance in crown rump length or nuchal translucency thickness had been evident. Noninvasive prenatal testing for common aneuploidy screening was negative.Ultrasound showed demise of one twin and scalp oedema and ascites in the surviving co-twin. Cardiothoracic ratio was elevated to 0.59 and tricuspid regurgitation was seen. Peak systolic velocity (PSV) of the middle cerebral artery (MCA) was increased to 2.18 multiples of median (MoM; 45.1 cm/s) and diastolic flow in the umbilical artery was absent. Cord insertion was velamentous and an arterial anastomosis was identified along the placental surface from the surviving twin to the placental cord insertion of the miscarried twin (Fig 1a and b).The couple were counselled extensively on management options that included termination of pregnancy, conservative management, or active intrauterine interventions. Within 24 hours, the patient opted to undergo rescue transfusion for fetal anaemia and interstitial laser cauterisation of the placental anastomosis. Interstitial laser cauterisation was performed using an 18G spinal needle inserted transplacentally under ultrasound guidance to the anastomotic artery close to the cord insertion of the miscarried twin. A 780-µm laser fibre was advanced to 3 mm beyond the needle tip. Cauterisation was started with a 20-W diode laser and stepped up to 40 W for 100 s. Fetal heart pulsation was checked intermittently and was normal throughout. Cessation of blood flow was confirmed by colour Doppler ultrasonography (Fig 1c).Intracardiac transfusion was performed

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“…However, we included only TTTS cases with double survivors at birth (to compare the outcome within twin pairs); therefore, renal function in survivors after single fetal demise requires further investigation. As recently shown, single fetal demise in TTTS twins not treated with laser can lead to severe renal ischemia and terminal renal failure due to acute exsanguination through the vascular anastomoses [ 16 ]. Since dichorionization of the placenta after complete laser surgery prevents acute exsanguination, this selection bias with double survivors may again have led to an underestimation of the risk of renal failure in the non-laser group.…”

Section: Discussionmentioning

confidence: 99%

Renal function in neonates with twin-twin transfusion syndrome treated with or without fetoscopic laser surgery

et al. 2017

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The aim of this study is to investigate the short-term renal function in neonates with twin-twin transfusion syndrome (TTTS), treated with fetoscopic laser surgery (laser group) or conservatively (non-laser group). Creatinine and urea levels and urine output were recorded in the first week after birth. Primary outcome was short-term renal dysfunction, defined as a creatinine level of >100 μmol/L during the first week postpartum. We evaluated 312 twins (laser group, n = 274; non-laser group, n = 38). Median creatinine and urea levels were lower in the laser group than in the non-laser group (71 versus 82 μmol/L, p = 0.002). Short-term renal dysfunction was lower in the laser group compared to the non-laser group (7.2 versus 34.4%, p < 0.001). Within the laser group, creatinine levels were significantly higher in the subgroup with incomplete laser surgery compared to twins with successful laser surgery (76 versus 69 μmol/L, p = 0.018). No differences were found between donors and recipients except for a higher incidence of oliguria in donors in the non-laser group on day 1. Conclusion: Short-term renal dysfunction occurs less frequently in TTTS twins treated with fetoscopic laser coagulation, particularly after complete surgery, suggesting that laser surgery may have a protective effect on renal function. What is Known: • Antenatally, donor twins in TTTS have severe oliguria due to chronic hypovolemia and impaired renal perfusion • Postnatally, donor twins may suffer from severe renal complications, particularly in TTTS twins treated conservatively. What is New: • The incidence of short-term renal failure in TTTS twins treated with complete laser surgery is low.• After incomplete laser surgery, the incidence of short-term renal dysfunction is increased.

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Renal Failure after Single Fetal Demise in Monochorionic Twins: Incidence and Description of a Case

Cited by 8 publications

References 4 publications

Single fetal demise in monochorionic pregnancies: incidence and patterns of cerebral injury

Single fetal demise in monochorionic pregnancies: incidence and patterns of cerebral injury

Combined interstitial laser cauterisation of placental anastomosis and intrauterine intracardiac transfusion following monochorionic co-twin demise: a case report

Renal function in neonates with twin-twin transfusion syndrome treated with or without fetoscopic laser surgery

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