Incidence, mechanisms, and patterns of fetal cerebral lesions in twin-to-twin transfusion syndrome

Quarello, E.; Molho, M.; Ville, Y.

doi:10.1080/14767050701449638

Cited by 102 publications

(65 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The resulting cerebral hypoperfusion and hypoxia cause a spectrum of injuries, ranging from multicystic encephalomalacia, germinal matrix or parenchymal haemorrhage, to grey matter lesions. 1 The incidence of cerebral injury in the surviving co-twin is estimated at 9-25%. 1,2 Because of this, special care must be taken to prevent back bleeding into the dying twin when selective termination is undertaken.…”

Section: Introductionmentioning

confidence: 99%

“…1 The incidence of cerebral injury in the surviving co-twin is estimated at 9-25%. 1,2 Because of this, special care must be taken to prevent back bleeding into the dying twin when selective termination is undertaken. Unlike fetal reduction in dichorionic twin pregnancies, selective termination in monochorionic pregnancies requires ablation of blood flow in the umbilical cord to prevent acute intrafetal transfusion.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Radiofrequency ablation for selective reduction in complex monochorionic pregnancies

Paramasivam

Wimalasundera

Wiechec

et al. 2010

BJOG

View full text Add to dashboard Cite

Monochorionic pregnancies present unique challenges for selective fetal reduction, as vaso-occlusive procedures are required to ablate blood flow, usually in the umbilical cord, to achieve asystole in the selected fetus. We describe a case series of 35 monochorionic pregnancies (27 twins and eight triplets) undergoing selective fetal reduction using radiofrequency ablation. All procedures were performed under local anaesthesia. The procedure was technically successful in all cases. The live born rate was 88.6%. One (2.9%) woman miscarried within 2 weeks of the procedure, and two (5.7%) babies were stillborn. The median gestation at delivery was 36 weeks of gestation (range 24-41 weeks). There were no maternal complications. The median gestational age at procedure was 17 + 3 weeks (range from 12 + 5 to 27 + 4 weeks). All women had antenatal magnetic resonance imaging (MRI) post procedure. There were two (5.7%) cases of abnormal brain imaging. Our experience suggests that radiofrequency ablation is a safe and effective procedure for fetal reduction in complicated monochorionic pregnancies.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation for selective reduction in complex monochorionic pregnancies

Paramasivam

Wimalasundera

Wiechec

et al. 2010

BJOG

View full text Add to dashboard Cite

show abstract

“…15 Single IUFD involved 11 donors and 8 recipients. The median gestational age at IUD was 23 [20][21][22][23][24][25][26][27][28] weeks, and the median interval between IUFD and intrauterine transfusion (IUT) was 12 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] hours. The median volume of blood transfused was 40 ml.…”

Section: Resultsmentioning

confidence: 99%

“…17 These complications are mainly due to acute and profound exsanguination of the live fetus into its dead co-twin and its placenta across placental vascular anastomoses at around the time of death. [5][6][7][8] The consequences of the death of one MC twin are probably related to angioarchitectural features of the MC placenta.…”

Section: Discussionmentioning

confidence: 99%

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto‐fetal transfusion syndrome

Quarello

Stirnemann

Nassar

et al. 2008

BJOG

View full text Add to dashboard Cite

Objective To evaluate the outcome of severely anaemic monochorionic (MC) twins surviving the death of their co-twin following early intrauterine rescue transfusion in cases of feto-fetal transfusion syndrome (FFTS).Study design We reviewed all MC pregnancies complicated with FFTS following primary management, in which a single intrauterine fetal death (IUFD) was diagnosed with certainty within 24 hours between January 1999 and December 2006. We included MC survivors who presented ultrasound or Doppler features of fetal anaemia following the death of their co-twin. Intrauterine transfusion (IUT) was given to all survivors who were anaemic.Results Nineteen MC twin pregnancies presented a single intrauterine death (IUD) associated with an anaemic co-twin. Median gestational age at IUD was 23 [20][21][22][23][24][25][26][27][28] weeks. The median interval between IUD and IUT was 12 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] hours. There were 58% (11/19) healthy survivors. Perinatal death rate was 26% (5/19) including 16% (3/19) intrauterine and 10% (2/19) neonatal deaths. Abnormal prenatal cerebral findings developed in 21% (4/19) cases, always within 1 month after the death of the co-twin. Considering occlusive techniques and other management separately, there were 64% (7/11) and 50% (4/8) healthy survivors, respectively, and perinatal death occurred in 36% (4/11) and 12.5% (1/8) of fetuses, respectively. Prenatal fetal cerebral lesions developed in 9% (1/11) of cases following occlusive techniques and in 37.5% (3/8) of fetuses when managed differently. The median gestational age at delivery in the survivors was 31 [25][26][27][28][29][30][31][32][33][34][35][36][37][38] weeks. ConclusionIn cases of FFTS with single anaemic survivors, early IUT could be offered following extensive counselling and close follow up.

show abstract

“…Inicialmente la incorporación del amniodrenaje produjo una disminución de la mortalidad, pero manteniendo secuelas neonatales relativamente altas (7). Posteriormente, y aceptado en la actualidad como la terapia de elección en este tipo de casos, se introdujo la coagulación láser de las comunicaciones vasculares causantes del STFF.…”

Section: Introductionunclassified

Complicaciones Tardías De La Terapia Láser Como Tratamiento De La Transfusión Feto-Fetal: Caso Clínico

et al. 2011

Rev. chil. obstet. ginecol.

View full text Add to dashboard Cite

RESUMENPresentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos. PALABRAS CLAVE: Gemelar, transfusión feto-fetal, secuencia anemia-policitemia SUMMARYWe describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severe twin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discrepancies in the hemoglobin levels between the twins, with no differences in blood volume.

show abstract

Incidence, mechanisms, and patterns of fetal cerebral lesions in twin-to-twin transfusion syndrome

Cited by 102 publications

References 27 publications

Radiofrequency ablation for selective reduction in complex monochorionic pregnancies

Radiofrequency ablation for selective reduction in complex monochorionic pregnancies

Outcome of anaemic monochorionic single survivors following early intrauterine rescue transfusion in cases of feto‐fetal transfusion syndrome

Complicaciones Tardías De La Terapia Láser Como Tratamiento De La Transfusión Feto-Fetal: Caso Clínico

Contact Info

Product

Resources

About