Management of a case of twin-to-twin transfusion syndrome by a combined surgical approach.

Abstract

OBJECTIVE:

The management of a case of severe twin-to-twin transfusion syndrome at 24 weeks of gestation is presented, using a combined surgical and medical approach.

METHODS:

Operative fetoscopy was used to coagulate placental vessels crossing the intertwin membranes. Repeated intrauterine transfusions were used to correct recurrent anemia in the donor twin. Selective three-dimensional placental angiography and directed histological analysis were used to study the placenta after delivery.

RESULTS:

Resolution of twin-to-twin transfusion syndrome was obtained by coagulation of placental anastomoses, but was followed by recurrent anemia in the donor twin. This was successfully treated by serial intrauterine blood transfusions, and 2 healthy twins were delivered at 31 weeks of gestation. One artery-to-vein anastomosis was demonstrated to be the only communication left between the two circulations.

CONCLUSIONS:

This case illustrates the limitations of placental surgery in twin-to-twin transfusion syndrome and highlights the need for ultrasound and Doppler follow-up of these high-risk fetuses to indicate further treatment. Placental anastomoses can be overlooked by macroscopic examination and injection technique, but can be demonstrated by placental angiography.

• Authors: P Van Peborgh, G Pelletier, B Suarez, Y Ville
• Journal: Fetal diagnosis and therapy (Fetal Diagn Ther) 1998 Mar-Apr Vol. 13 Issue 2 Pg. 75-8 ISSN: 1015-3837 [Print] Switzerland
• PMID: 9650650 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Anemia (etiology, therapy)
• Angiography
• Blood Transfusion, Intrauterine
• Female
• Fetal Diseases (therapy)
• Fetofetal Transfusion (surgery, therapy)
• Fetoscopy
• Gestational Age
• Humans
• Placenta (blood supply)
• Pregnancy
• Pregnancy Outcome