Specific complications of monochorionic twin pregnancies: twin–twin transfusion syndrome and twin reversed arterial perfusion sequence

Chalouhi, G. E.; Stirnemann, J.; Salomon, Laurent; Essaoui, M.; Quibel, T.; Ville, Y.

doi:10.1016/j.siny.2010.09.003

Cited by 92 publications

(70 citation statements)

References 101 publications

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“…A evolução clínica depende da combinação dos efeitos da insuficiência placentária no gêmeo com RCF com as transferências de sangue entre os gêmeos através de anastomoses placentárias. [1][2][3] As RCF-S podem ser classificadas de acordo com as características do fluxo diastólico na artéria umbilical no gêmeo com RCF; permitindo assim a diferenciação de grupos clínicos com prognósticos diferentes. O tipo I de RCFs tem fluxo diastólico normal e é de relativamente bom prognóstico.…”

Section: Introductionunclassified

“…1,4 A estratégia no manejo de RCF-S com Doppler anormal da artéria umbilical (tipos II e III) continua a ser um desafio, e pode incluir terapia fetal eletiva ou estreita vigilância com a terapia fetal ou parto eletivo na presença de deterioração fetal grave. 1,2 As conseqüências adversas decorrentes da morte potencial do gêmeo com RCF-S podem ser evitadas desvinculando a circulação entre os dois fetos. Isso pode ser feito desfazendo as anastomoses placentárias através da fotocoagulação a laser de vasos comunicantes ou, em casos extremos, através da realização da oclusão do cordão umbilical quando o prognóstico para o feto menor já é muito reservado.…”

Section: Introductionunclassified

“…Isso pode ser feito desfazendo as anastomoses placentárias através da fotocoagulação a laser de vasos comunicantes ou, em casos extremos, através da realização da oclusão do cordão umbilical quando o prognóstico para o feto menor já é muito reservado. 1,2 Provavelmente não há melhor ou única estratégia, uma vez que as decisões serão finalmente influenciadas pela gravidade da RCF, idade gestacional, a vontade dos pais e questões técnicas.…”

Section: Introductionunclassified

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Restrição de crescimento seletiva em gestação gemelar monocriônica: relato de caso

Filho¹,

Feitosa

Feitosa³

et al. 2015

Rev. Med. UFC

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RESUMOA restrição de crescimento fetal (RCF) ocorre em aproximadamente 3 a 10% das gestações únicas, em 9,1% de todos os gêmeos, e em 9,9% dos gêmeos monocoriônicos. O déficit de crescimento pode comprometer apenas um dos gêmeos de forma seletiva (RCF-S). A morte espontânea do gêmeo com restrição pode resultar em morte concomitante ou deficiência neurológica grave do outro gêmeo.Há classificação em três subtipos para essa entidade clínica, onde os de tipo I (Doppler normal) são conduzidos de forma expectante com avaliação periódica ao Doppler. Para os subtipos II (Doppler anormal mantido) e os subtipos III (Doppler anormal intermitente) não há consenso na literatura, com tendência a realização do laser para separação das circulações com o intuito de evitar as conseqüências adversas decorrentes da morte potencial do gêmeo com RCFs.O objetivo deste relato de caso é apresentar uma evolução de RCFs Tipo I conduzida de forma conservadora com resultado satisfatório e discutir os aspectos desta importante entidade na obstetrícia. Palavras-chave:Retardo do crescimento fetal. Gravidez de gêmeos. Ultrassonografia pré-natal. Monitorização fetal. Conduta expectante. ABSTRACTThe fetal growth retardation (FGR) occurs in approximately 3-10% of singleton pregnancies, 9.1% of all twins, and in 9.9% of monochorionic twins. The growth deficit can compromise only one twin selectively (FGR-S). Spontaneous twin death restriction can result in death or serious neurological concomitant deficiency of other twin.There are classified into three subtypes for this clinical entity, where the type I (normal Doppler) are conducted in an expectant way with periodic evaluation by Doppler echocardiography. For subtypes II (abnormal Doppler maintained) and subtypes III (intermittent abnormal Doppler) there is no consensus in the literature, with a tendency to completion of the laser to separate the circulations in order to avoid the adverse consequences of the potential death of twin with RCFs .The objective of this report is to present a progress RCFs Type I conducted conservatively with satisfactory results and discussing this important entity in obstetrics.

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Section: Introductionunclassified

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Restrição de crescimento seletiva em gestação gemelar monocriônica: relato de caso

Filho¹,

Feitosa

Feitosa³

et al. 2015

Rev. Med. UFC

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“…Different treatment methods are in use including cord coagulation, ligation of the cord or photocoagulation of the anastomoses, interstitial laser therapy and radiofrequency ablation [3][4][5][6] . Neither the optimal Scheier /Molina Fetal Diagn Ther 2012;31: [35][36][37][38][39][40][41] 36 time nor the optimal method of treatment has been established beyond doubt.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Twin Reversed Arterial Perfusion Sequence following Treatment with Interstitial Laser: A Retrospective Study

Scheier

Molina²

2011

Fetal Diagn Ther

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Objectives: To determine the outcome of twin reversed arterial perfusion (TRAP) sequence treated with or scheduled for treatment with interstitial laser therapy. Methods: This is a retrospective study on ten pregnancies diagnosed with TRAP sequence. Seven of the ten pregnancies were treated with interstitial laser therapy, and two pregnancies were scheduled for later treatment. One pregnancy was treated with fetoscopic laser ablation and excluded from analysis. The delivery reports of all pregnancies were collected, the neonatal health status recorded and the median time of delivery and the treatment to delivery interval calculated. Results: Six of seven pump fetuses in TRAP pregnancies treated with interstitial laser therapy at a median of 16+2 (range 13+1 to 20+3) gestational weeks were born healthy at a median of 38+0 (range 34+3 to 40+6) gestational weeks. One fetus treated with interstitial laser died after the procedure at 20+3 weeks. Two pump twins scheduled for later treatment died before the gestational age of 16 weeks. The median treatment to delivery interval for the surviving fetuses was 153 days (range 128-194). Conclusion: Treatment of TRAP sequence by interstitial laser therapy is feasible from the 13th week of gestation and has a good outcome.

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“…In all of these high-risk situations, death of the most affected twin can trigger an exsanguination of the survivor into the dead twin and its placenta, thus threatening the survivor with death or the development of ischemic lesions in various organs, but primarily the brain, in about 20% of cases for either condition. 2 Acardiac anomaly, one of the most severe human malformations, is a rare complication unique to monochorionic multiple pregnancies. In this condition, the primary malformation is the lack of a well-defined cardiac structure in one twin (the acardiac twin), which is kept alive by its structurally normal co-twin (the pump twin) through a superficial artery-to-artery placental anastomosis.…”

Section: Introductionmentioning

confidence: 99%

Advances in Ultrasonic Assessment of Acardiac Twin

Stamatian¹,

Mureşan²,

Caracostea³

et al. 2011

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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The development of an acardiac anomaly, one of the most severe human malformations, is a rare complication unique to monochorionic multiple pregnancies. In this condition, the primary malformation is the lack of a well-defined cardiac structure in one twin (the acardiac twin), which is kept alive by its structurally normal co-twin (the pump twin).The final diagnosis for a twin pregnancy with an acardiac twin may be established after the 9th week, when the cephalic extremity and limbs can be precisely determined.Direct signs that lead to the diagnosis of an acardiac twin include the absence of cardiac and fetal movements, difficult visualization of the trunk and cephalic poles, thickening of subcutaneous tissue and the presence of umbilical artery reverse flow towards the acardiac fetus mass. The pump fetus may demonstrate hydramnios, cardiomegaly and heart failure.Once an acardiac anomaly is diagnosed, both the acardiac and pump twins should be assessed to classify the pregnancy according to prognostic factors based on the size and growth of the acardiac twin and the cardiovascular condition of the pump twin. Assessing the extent of heart damage in the pump fetus is a key step in pregnancy management.There are two available options, either conservative or interventional, for the management of these pregnancies. Serial ultrasound surveillance is important for detecting any worsening of the condition, which may suggest the need for interventions to optimize the pump-twin's chance for survival.We performed a retrospective analysis of three cases of monochorionic twin pregnancies diagnosed with a twin reversed arterial perfusion (TRAP) sequence during the first and second trimesters. We compared our data with those offered by a review of the literature.

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Specific complications of monochorionic twin pregnancies: twin–twin transfusion syndrome and twin reversed arterial perfusion sequence

Cited by 92 publications

References 101 publications

Restrição de crescimento seletiva em gestação gemelar monocriônica: relato de caso

Restrição de crescimento seletiva em gestação gemelar monocriônica: relato de caso

Outcome of Twin Reversed Arterial Perfusion Sequence following Treatment with Interstitial Laser: A Retrospective Study

Advances in Ultrasonic Assessment of Acardiac Twin

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