Utility of Doppler velocimetry in predicting outcome in twin reversed-arterial perfusion sequence

Dashe, Jodi S.; Fernandez, Carlos O.; Twickler, Diane M.

doi:10.1067/mob.2001.113906

Cited by 75 publications

(50 citation statements)

References 8 publications

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“…Others have also noted a poor prognosis for the pump twin with cardiomegaly, in 3 of 4 fetuses intrauterine death had occurred. Brassard et al [17] found that the outcome of the pump twin was based on hemodynamic criteria, in agreement with other studies [18,19]. This procedure must be arranged before irreversible heart failure develops.…”

Section: Discussionsupporting

confidence: 70%

Monopolar Thermocoagulation in the Management of Acardiac Twins

Chang

Liou²,

Hsieh³

et al. 2004

Fetal Diagn Ther

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Objective: To demonstrate the equipment setup and the application of monopolar thermocoagulation in the management of acardiac twins. Methods: We described 2 cases of acardiac acephalus twins who developed congestive heart failure and polyhydramnios at 20 weeks of gestation. A monopolar wire electrode was inserted through a 14-gauge trocar under ultrasound guidance. The inter-twin circulation was interrupted and confirmed by color Doppler flow examination. Results: Case 1 was detected at 20 weeks of gestation with progression to early signs of fetal congestive heart failure at 22 weeks. This case had smooth operative procedure and delivered a healthy infant at 32 weeks. Case 2 was referred at 24 weeks of gestation with marked fetal congestive heart failure. Although thermocoagulation cessed the inter-twin perfusion, the fetus died in utero 12 h later with persistent irreversible circulatory compensation. Conclusion: Monopolar thermocoagulation was an effective and generally available alternative technique to fetal endoscopic surgery for the interruption of vascular communication between acardiac twins.

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Section: Discussionsupporting

confidence: 70%

Monopolar Thermocoagulation in the Management of Acardiac Twins

Chang

Liou²,

Hsieh³

et al. 2004

Fetal Diagn Ther

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“…Se han propuesto para el manejo de estos casos la razón peso acardio/peso bomba (21) y la evaluación de la resistencia al flujo: gran diferencia en el índice tendría mejor pronóstico (menor flujo al acardio) (22), pero se mantiene la controversia entre tratamiento preventivo (semana 16) o tratamiento curativo a la aparición de complicaciones (insuficiencia cardiaca del feto dador).…”

Section: Discussionunclassified

Vía Del Nacimiento en Gemelar Monocoriónico Con Transfusión Intergemelar Y Terapia in Utero

2004

Rev. chil. obstet. ginecol.

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RESUMENEl propósito de la comunicación es revisar la vía del parto en embarazo gemelar complicado por Síndrome de Transfusión Gemelo-Gemelo (STGG) y por gemelo acardio con perfusión arterial reversa. La placentación del gemelar monocoriónico por sus anastomosis arteriales y venosas genera esas complicaciones que se asocian a una mortalidad cercana a 100% cuando no son tratadas en el período antenatal. Se describen dos casos de gemelar monocoriónico complicado, uno con STGG y otro, un acardio con perfusión reversa, ambos con diagnóstico ultrasónico precoz en primer trimestre y comienzo del segundo, que fueron exitosamente tratados in útero con coagulación láser sobre anastomosis vascular placentaria y sobre arteria umbilical pelviana obteniendo mejoría hemodinámica y recuperación de la funcionalidad placentaria. Se discuten aspectos generales del cuidado médico antenatal e intraparto del embarazo gemelar y específicamente del gemelar monocoriónico complicado. Se concluye que la terapia in útero fue exitosa además de mejorar el pronóstico puede favorecer la vía vaginal de parto.PALABRAS CLAVE: embarazo gemelar monocoriónico, anastomosis vasculares, terapia láser, parto vaginal SUMMARYThe aim of this communication is to review the way of delivering twin pregnancy complicated by either Twin to Twin Transfusion Syndrome (TTTS) or acardic twin with reverse arterial perfusion. The monochorionic placentae is characterised by superficial or deep vascular anastomosis which leads to the complications mentioned above, which are associated with almost 100% mortality when they are not treated antenatally. We describe two cases of severe TTTS and acardic twin with reverse arterial perfusion both diagnosed antenatally during the first and early second trimester of pregnancy on which laser treatment either on placental vascular anastomoses or pelvic single umbilical artery were done successfully. In addition of this we discuss some clinical aspects of prevention of premature delivery, antenatal and intrapartum medical care for twin pregnancy in general and specifically for complicated monochorionic twin pregnancy. We conclude that a successful fetal therapy improves pregnancy prognosis and makes possible vaginal delivery.

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“…50%. Dashe et al [17] in a series of 6 twin pregnancies complicated by an acardiac fetus found that an umbilical artery resistivity index difference of ! 0.05 indicated a large shunt between the pump and the acardiac and was present in all 3 cases that ended up with a poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Dichorionic Triamniotic Triplet Pregnancy Complicated by Acardius Acormus

et al. 2009

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This report describes an acardiac fetus of the acormus phenotype in a triplet pregnancy. The diagnosis was confirmed at 15 weeks. In the absence of signs of heart failure in the co-fetus the pregnancy was managed conservatively. The pregnancy was complicated by preterm labour and the fetuses were delivered at 26+5 weeks. The prenatal diagnosis of the acormus phenotype with a well-developed cephalic pole is extremely rare and has never been described antenatally in a higher order multiple pregnancy. We suggest that this rare acardiac fetus phenotype may have a different pathophysiology than those of other phenotypes. The report also summarizes the perinatal outcomes of triplet pregnancies complicated by an acardiac fetus, where the median gestational age at delivery is 26–27 weeks, and discusses the possible therapeutic interventions.

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Utility of Doppler velocimetry in predicting outcome in twin reversed-arterial perfusion sequence

Cited by 75 publications

References 8 publications

Monopolar Thermocoagulation in the Management of Acardiac Twins

Monopolar Thermocoagulation in the Management of Acardiac Twins

Vía Del Nacimiento en Gemelar Monocoriónico Con Transfusión Intergemelar Y Terapia in Utero

Dichorionic Triamniotic Triplet Pregnancy Complicated by Acardius Acormus

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