Case of resuscitation from cardiac failure by intrauterine transfusion after single fetal death in monochorionic twin pregnancy

Abstract

In case of a single fetal death in monochorionic twin pregnancy, the surviving fetus is thought to become hypovolemic. However, there is no report of any evidence of fetal circulatory insufficiency in such cases. We present a case of a single fetal death in a monochorionic twin pregnancy with type III selective intrauterine growth restriction that involved low fractional shortening, high myocardial performance index, elevated pulsatility index in the middle cerebral artery and fetal ascites. After immediate intrauterine transfusion, each parameter improved promptly. The surviving baby grew up without cardiac and neurological complications. To the best of our knowledge, this is the first report on transient circulatory insufficiency and decreased cardiac function in the surviving fetus.

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

“…Evidence of transient cardiac failure has been reported after single fetal death in monochorionic twins and immediate intrauterine transfusion has been advocated to restore the circulatory volume. 2 This case did not have features of TTTS although ascites, cardiomegaly, and tricuspid regurgitation were noted after co-twin demise and before intrauterine intervention. Although fetal anaemia was ascertained and hypovolaemic shock was likely present, it is not always possible to determine whether the ascites is secondary to circulatory insufficiency or bowel complications.…”

“…1 Feto-fetal haemorrhage through the placenta anastomosis leads to acute hypovolaemia and results in fetal anaemia, cerebral damage or death of the co-twin. 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.…”

Fetal Cardiac Function: Myocardial Performance Index

“…The recipients' MPI decreased promptly after this procedure and cardiac function was normal after birth. 92 In studies concerning diabetic mothers, MPI was elevated in the group with adverse outcomes and served as an independent predictor of adverse outcome. 70,77 A cut-off value >= 0,52 was proposed.…”

“…Intrauterine transfusion (IUT) may prevent poor perinatal outcomes; the majority of co-twins of a single FD in an MCTP with superficial anastomoses exhibited poor outcomes. The recipients’ MPI decreased promptly after this procedure and cardiac function was found to be normal after birth [ 92 ].…”