Fetal exsanguination following intrauterine angiographic assessment and selective termination of a hydrocephalic, monozygotic co‐twin

Donnenfeld, Alan E.; Glazerman, Larry R.; Cutillo, Denise; Librizzi, R.; Weiner, Stuart

doi:10.1002/pd.1970090502

Cited by 21 publications

(5 citation statements)

References 14 publications

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“…This discrepancy can be explained only when the anastomoses are carefully delineated, and the circumstances of birth are known. This topic was especially well discussed in the case reports by Donnenfeld et al ( 1989 ) , and Bendon and Siddiqi ( 1989 The smaller twin was growth-restricted because of its velamentous insertion of the cord. This case does not represent a twin transfusion syndrome.…”

Section: Twin-to-twin Transfusion Syndromementioning

confidence: 94%

“…They were nearly uniformly successful, but the possibility of destruction of the dividing membranes exists with this technique. Selective feticide can then be undertaken when fetal trisomy is diagnosed by any of these techniques (Kerenyi and Chitkara 1981 ;Chitkara et al 1989 ; see also Donnenfeld et al 1989 ) . Pijpers et al ( 1988 ) studied 83 pregnancies and obtained karyotypes of both twins in 77 cases (93%).…”

Section: Cytogenetics and "Heterokaryotypic Mz Twins"mentioning

confidence: 98%

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Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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Section: Twin-to-twin Transfusion Syndromementioning

confidence: 94%

Section: Cytogenetics and "Heterokaryotypic Mz Twins"mentioning

confidence: 98%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

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“…The possibility of the development of DIC or exsanguination after the death of one twin in utero may have important implications in the treatment of the twin-to-twin transfusion syndrome or in cases of fetal anomalies by selective feticide of one twin. This has been practiced so as to allow the continuation of pregnancy for the other twin [11,42]. The possibility of serious fetal damage in the survivor as outlined above must be considered.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, Larroche and her colleagues [26] suggested that in utero damage to the brain may result from acute hypotension. Donnenfeld et al [11] found that, after unsuccessful elective termination of a hydrocephalic twin with potassium chloride injection, the normal twin exsanguinated. Fusi et al [15] illustrated a monochorionic twin with acute exsanguination after fetal death.…”

Section: Outcome Of the Surviving Twinmentioning

confidence: 99%

Intrauterine Death in Multiple Gestation

Liu

Benirschke²,

Scioscia³

et al. 1992

Acta genet. med. gemellol.: twin res.

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Intrauterine death of one fetus in a multiple gestation is associated with significant morbidity and mortality in the surviving infant. This study is a retrospective review of 38 twin and 3 triplet gestations involving the intrauterine death of at least one fetus. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed. Three cases involved the recent stillbirth of both twins, the remaining cases involved a surviving infant. In one case, neonatal death of a surviving twin occurred on day 19. In two sets of triplets, two stillbirths occurred, in the third case two infants were liveborn. The incidence of preterm delivery was 34%, which decreased to 18% if fetal cotwin death had occurred before 20 weeks gestation. Cesarean section was the method of delivery in 16 cases. There was an excess of velamentous cord insertions, which was most pronounced in the stillborn twin. Monochorionic placentation was found in 72%, also an excess.Neurological damage was known to have occurred in 19 of the 39 surviving infants. Fifteen of these 19 (79%) were associated with monochorionic placentation. The neurologically damaged twin infants, when compared to the normal infants, had the cotwin die later in gestation (31 vs 16.5 weeks), had a shorter duration between the death of the cotwin and delivery (2.5 vs 21 weeks), and delivered earlier in gestation (36.5 vs 39.5 weeks). The probable cause of neurological damage, in our opinion, was either exsanguination into the dead twin fetus, or disseminated intravascular coagulation which occurred in at least 13 cases. The incidence of antepartum death in a multiple gestation, and the potential for neurological damage is probably higher than previously thought. A review of the literature is presented and the clinical implications of this phenomenon are discussed.

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“…In utero sampling has been done in only two published cases in addition to this one (Donnenfeld et al, 1989, Fusi et al, 1991. Neither found any clotting abnormality.…”

Section: **No Reference Range Availablementioning

confidence: 99%

The Sequentialin Utero Death of Heterokaryotic Monozygotic Twins. A Case Report and Literature Review

et al. 1996

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A case of monozygotic twins in a 19‐year‐old primigravida is presented. Ultrasound examination at 15 weeks' gestation showed one twin to have a cystic hygroma and hydrops fetalis. The other twin appeared normal. The twins appeared to occupy the same amniotic cavity. Fluid was taken from the cystic hygroma under ultrasound guidance for karyotyping and this showed 45,XO chromosomes. Conservative management was adopted. Serial ultrasound examination showed deteriorating hydrops and at 26 weeks the first twin died. Intensive monitoring of the remaining twin was undertaken with weekly ultrasound, cardiotocography (CTG), and clotting screens. At 29 weeks' gestation the CTG and clotting were normal, but ultrasound revealed that multicystic encephalomalacia had developed in the second twin. A very thin dividing membrane was seen for the first time between the twins. The parents decided to terminate the pregnancy. Prior to an intracardiac potassium chloride injection, a fetal blood sample was taken which revealed 46,XX chromosomes and a normal clotting screen including natural anticoagulant levels. Labour was then induced. Delivery took place 5 h later and the woman made an uneventful recovery. The mechanism for genetic differences between monozygotic twins is discussed and the literature reviewed. A non‐disjunction event around the time of splitting of the twins is proposed as the cause. The prognosis for the remaining twin is also discussed, as is the pathogenesis of the cerebral damage.

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Fetal exsanguination following intrauterine angiographic assessment and selective termination of a hydrocephalic, monozygotic co‐twin

Cited by 21 publications

References 14 publications

Multiple Pregnancies

Multiple Pregnancies

Intrauterine Death in Multiple Gestation

The Sequentialin Utero Death of Heterokaryotic Monozygotic Twins. A Case Report and Literature Review

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