Successful Intrauterine Management of Severe Feto-Fetal Transfusion in a Monochorionic Triplet Pregnancy Using Bipolar Umbilical Cord Coagulation

Abstract

Triplet-to-triplet transfusion is a rare clinical complication of monochorionic pregnancies. We present such a case in a monochorionic triamniotic triplet gestation. After a single fetal demise an ongoing twin-to-twin transfusion continued in the surviving triplets. The donor triplet had ultrasound evidence of secondary structural brain damage. The pregnancy was successfully managed with bipolar umbilical cord coagulation of the donor triplet and spontaneous vaginal delivery of the recipient triplet. The case highlights the clinical spectrum and diagnostic and management options that present themselves in these high-risk pregnancies.

Monochorionic Triplets Complicated by Fetofetal Transfusion Syndrome: A Case Series and Review of the Literature

“…From 1990 to 2010, 22 articles met the inclusion criteria and we identified 25 MC and 97 DC triplet pregnancies with TTTS [2,3,6,7,8,9,10,11,12,13,14,15,16,17,18,19,21,22,23,24,25]. Quintero stage, in the reported cases including the cases in this study, was stage I in 7% (2/27) stage II in 15% (4/27), stage III in 45% (12/27) and stage IV in 33% (9/27) of the MC triplets.…”

“…The prognosis of TTTS for MC triplets is considered to be different from that for DC triplets and has been reported to be severe, with higher rates of mortality and preterm birth, despite interventions [7,10]. However, the literature on triplets and higher-order multiple births with TTTS consists mainly of case reports and small series, most of which fail to discuss placentation [3,11,12,13,14,15,16,17,18,19]. …”

Multiple Pregnancies

“…Hydrops correlated with poor survival in this study, but decompression by amniocentesis was not bene fi cial in the ultimate outcome. The condition has also been described in one of triplets and higher multiple births, as, for instance, in the triplets described by Sekiya et al ( 1973 ) , another by Chasen et al ( 2002 ) , and yet an additional case reported by Baschat et al ( 2003 ) . Berg et al ( 2002 ) reported onset of TTTS at 11 weeks in an ART-conceived quadruplet gestation with quadramnionic, trichorionic placenta.…”

An Experience of Laser Surgery for Feto-Fetal Transfusion Syndrome Complicated with Unexpected Feto-Fetal Hemorrhage in a Case of Monochorionic Triamniotic Triplets

“…FFTS in monochorionic triplets is a rare clinical entity, which shares the principal adverse prognosis of twin-twin transfusion syndrome. Advances in several treatment options [7,8] , including SLPCV, have been made, especially for twin cases. Recently, favorable perinatal outcomes regarding the morbidity and mortality of twin-twin transfusion syndrome after laser surgery have been reported [9][10][11][12] .…”

“…This condition is thought to occur from the imbalanced blood sharing between the monochorionic fetuses through the placental vascular anastomoses. Because of the poor prognosis, the termination of the whole pregnancy or selective termination of a sick fetus using umbilical cord coagulation has been applied during gestation for triplet FFTS [7,8] .…”