Management of single fetal death in twin‐to‐twin transfusion syndrome: a role for fetal blood sampling

Senat, M. V.; Bernard, Jean‐Pierre; Loizeau, S.; Ville, Y.

doi:10.1046/j.1469-0705.2002.00815.x

Cited by 81 publications

(56 citation statements)

References 24 publications

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“…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%

“…It is now well established that increased mortality and morbidity of the survivors are related to acute exsanguinations into the dead fetus and its placenta at around the time of death. [6][7][8][9] Denbow et al 10 and Taylor et al 11 have demonstrated that the outcome of MC pregnancies as well as When the diagnosis of single IUD is made in an MC pregnancy, one should seek ultrasound and Doppler features of fetal anaemia. 10 Acute and profound anaemia can cause death or ischemia of several organs such as brain, liver, bowel, kidneys and limbs related to low blood flow.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

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

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“…Such a mechanism has never been documented. In contrast, fetal anemia resulting from perimortem feto-fetal hemorrhage from the surviving to the dead twin through placental vessels has been documented in several cases 1,5 . Paradoxical anemia in the recipient twin and polycythemia in the donor twin, as in our case, can be explained by such a mechanism when the donor twin dies first.…”

mentioning

confidence: 99%

“…Our endoscopic observation lends further support to perimortem feto-fetal hemorrhage as the operating mechanism of injury after demise of a monochorionic twin. Moreover, our case suggests that these events may take place in less than 3 h. Understanding the timing and magnitude of this phenomenon may contribute to the development of potential treatment strategies, such as intrauterine fetal transfusion of the surviving twin after demise of a monochorionic twin 3,5 . The risks and benefits of this therapeutic intervention deserve further evaluation.…”

mentioning

confidence: 99%

Fetoscopic demonstration of perimortem feto–fetal hemorrhage in twin–twin transfusion syndrome

Quintero¹,

Martı́nez

Bermúdez³

et al. 2002

Ultrasound in Obstet & Gyne

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“…The second theory suggests that blood pressure drops acutely in the dying twin and causes exsanguination of the survivor to the dying twin through placental vascular anastomoses. 2 The two theories share the common feature that placental anastomoses are functional and connect the two fetal circulations. Therefore, photocoagulation of placental anastomoses and restoration of the two fetal circulations represent the rationale for laser therapy.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Twin-Twin Transfusion Syndrome

Rossi¹,

Addario²

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Twin-twin transfusion syndrome (TTTS) is a complication unique to monochorionic twin pregnancies, in which the two twins share a common placenta and unequal blood exchange from one twin (donor) to the cotwin occurs through placental arterovenous anastomoses. The diagnosis is posed with the sonographic detection of oligohydramnios in the donor's sac, as a consequence of hypovolemia, and polyhydramnios in the recipient's sac, resulting from hypervolemia. The severity of TTTS is assessed according to Quintero staging system, which is based on five stages that range from visualization of the donor's bladder to intrauterine demise of one or both twins. Because laser therapy has revealed the optimal treatment for TTTS, management of twins affected with TTTS consists in preoperative and postoperative assessment of the twins by ultrasound examination. The aim of this review was to describe the diagnosis and management of TTTS and discuss controversies and limitations of current literature.

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Management of single fetal death in twin‐to‐twin transfusion syndrome: a role for fetal blood sampling

Cited by 81 publications

References 24 publications

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

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

Fetoscopic demonstration of perimortem feto–fetal hemorrhage in twin–twin transfusion syndrome

Diagnosis and Management of Twin-Twin Transfusion Syndrome

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