Resolution of superimposed pre‐eclampsia, and improvement in umbilical artery flow in a surviving twin after intrauterine demise of its co‐twin

Narasimhulu, Deepa Maheswari; Karakash, Scarlett; Rankin, Linda; Minkoff, Howard

doi:10.1111/jog.12725

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Most reports present cases of reduction on fetal indication. A few cases described lessening or resolution of pre-eclampsia after intrauterine fetal death of one fetus in a multiple pregnancy complicated by pre-eclampsia 5–8. We performed a literature search on recovery of pre-eclampsia after multifetal pregnancy reduction, of which after selection on title and abstract remained six full-text paper with a total of eight cases9–14 (table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Because of the extreme early pregnancy and the severity of the maternal disease with increased risk of maternal morbidity and neonatal morbidity and mortality, she and her partner were counselled about termination of pregnancy on maternal indication. In addition, they were counselled about fetal reduction of the monochorionic couple resulting in a singleton pregnancy, thus reducing placental load and possibly improving her clinical condition of pre-eclampsia 5–8. She and her husband opted for the reduction of the monochorionic couple of the triplet which was performed at 16 weeks and 3 days of gestation by intracardiac infusion of potassium chloride in one of the monochorionic twins after which both fetuses deceased.…”

Section: Treatmentmentioning

confidence: 99%

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Recovery of second trimester pre-eclampsia after fetal reduction of a triplet

Weg

Groot²,

Pajkrt

et al. 2019

BMJ Case Rep

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Women with a multiple pregnancy are at increased risk of developing hypertensive disorders of pregnancy. We describe a case of a dichorionic triamniotic triplet pregnancy complicated by severe hypertension, proteinuria and maternal symptoms, fitting with the diagnosis of pre-eclampsia, apart from the early gestational age of only 16 weeks. After reduction of the monochorionic pair, the disease resolved and pre-eclampsia was diagnosed again at 30 weeks of gestation, resulting in a delivery on maternal indication at 33 weeks of gestation. In a review of the literature, we found six papers including eight cases on multifetal pregnancy reduction on maternal indication. Multifetal pregnancy reduction resulted in a prolongation of pregnancy of two to 21 weeks and may be considered in extreme early onset pre-eclampsia in dichorionic multiple pregnancies.

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Section: Discussionmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Recovery of second trimester pre-eclampsia after fetal reduction of a triplet

Weg

Groot²,

Pajkrt

et al. 2019

BMJ Case Rep

View full text Add to dashboard Cite

show abstract

“…In twin pregnancies, as compared with singletons, there is a higher incidence of pre‐eclampsia – which also tends to develop earlier and to be more severe. Some reports describe resolution of severe pre‐eclampsia after single fetal demise or the selective fetocide of a severely growth‐restricted twin followed by a favourable outcome for the surviving twin. In such cases, it is assumed that the placental involution and death following the fetal death and thereby the cessation of the placental production of whatever factor or factors led to the pre‐eclampsia are the causes of its resolution …”

Section: Discussionmentioning

confidence: 99%

Triploid twin gestation with single fetal demise associated with partial mole and pre‐eclampsia

Okumura

Fushida

Francisco

et al. 2017

Australas J Ultrason Med

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Both partial mole and twin gestation are conditions associated with the risk of the early onset of pre-eclampsia. In cases of twin gestation, the death or selective termination of a severely growth-restricted fetus may lead to the reversal of maternal pre-eclampsia because of the involution or death of the pathological placenta, as has been reported by some authors. This case demonstrates that in a twin triploid gestation, in spite of the demise of one of the fetuses, the respective partial molar placenta can continue to grow and may contribute to the development or to the worsening of the pre-eclampsia.

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“…Few cases of resolution of preeclampsia after spontaneous intrauterine death of one twin or selective termination of a dichorionic pregnancy have been reported ( 1 , 6 , 7 ) . Narasimhulu et al ( 8 ) reported resolution of superimposed preeclampsia in a surviving fetus after the intrauterine demise of its co-twin and suggested that placental involution after fetal demise was the key to resolution of preeclampsia (resolution period take 1 to 3 weeks). However, according to our cases, even if the fetus dies, preeclampsia could not be curable unless placental seperation occurred.…”

Section: Discussionmentioning

confidence: 99%

Do preeclampsia symptoms resolve after intrauterine death of a fetus?

Balcı¹,

Bodur²,

Tohma³

et al. 2016

tjod

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We present two cases of twin pregnancies without resolution of preeclamptic symptoms after intrauterine death of one twin.Case 1:A nulliparous woman aged 37 years was referred at 26 weeks of gestation because of arterial hypertension, edema, and growth restriction in one twin. Three weeks later the restricted twin died. During the following three weeks, ultrasound examinations showed a reduced growth velocity of the surviving fetus and reversed umbilical flow. At the end of the 34th week of gestation, cesarean section was performed and a healthy female infant was delivered.Case 2:A nulliparous woman aged 33 years with a 27-week twin pregnancy was referred because of arterial hypertension and discordant growth. The restricted twin died at 31 weeks of gestation. Following the death, within two weeks the growth of the co-twin started to slow down and reversed end diastolic flow presented. At the end of the 33rd week of gestation, cesarean section was performed and a healthy female infant was delivered.The interesting point of these cases was the secondary effects on the co-twins. During the time after intrauterine deaths of one twin, the surviving fetuses started to show a reduced growth velocity and reversed umbilical flow and mothers had increased blood pressure and proteinuria again. We think that both cases are evidence of late on-set systemic maternal effects (such as systemic maternal endothelial activation and/or systemic maternal inflammatory response) depends on preeclampsia.

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Resolution of superimposed pre‐eclampsia, and improvement in umbilical artery flow in a surviving twin after intrauterine demise of its co‐twin

Cited by 5 publications

References 11 publications

Recovery of second trimester pre-eclampsia after fetal reduction of a triplet

Recovery of second trimester pre-eclampsia after fetal reduction of a triplet

Triploid twin gestation with single fetal demise associated with partial mole and pre‐eclampsia

Do preeclampsia symptoms resolve after intrauterine death of a fetus?

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