Management of single fetal death in twin-to-twin transfusion syndrome: a role for fetal blood sampling
| Autor: | M. V. Senat, Jean-Pierre Bernard, Yves Ville, S. Loizeau |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Pregnancy
medicine.medical_specialty Periventricular leukomalacia Blood transfusion Radiological and Ultrasound Technology business.industry Obstetrics medicine.medical_treatment Obstetrics and Gynecology General Medicine medicine.disease Twin-to-twin transfusion syndrome Reproductive Medicine Obstetrics and gynaecology medicine Gestation Radiology Nuclear Medicine and imaging Monochorionic twins business Twin Pregnancy |
| Zdroj: | Ultrasound in Obstetrics and Gynecology. 20:360-363 |
| ISSN: | 0960-7692 |
| DOI: | 10.1046/j.1469-0705.2002.00815.x |
| Popis: | Objective Intrauterine death of one twin in monochorionic pregnancies is associated with an increased mortality and morbidity of the cotwin. This is likely to occur as a consequence of acute hemodynamic changes due to feto–fetal hemorrhage at the time of death of the cotwin. We assessed the role of fetal blood sampling and intrauterine transfusion to rescue the survivor. Materials and methods We managed 12 cases of single intrauterine death at between 17 and 26 weeks' gestation in monochorionic twins complicated by twin-to-twin transfusion syndrome (TTTS). All these cases had been treated either by laser therapy or by serial amniodrainage. When the demise of one twin occurred, ultrasound-guided fetal blood sampling was performed in the surviving twin using a 20-gauge needle within 24 h of death. Intrauterine transfusion was performed at the same time in cases where the survivor was anemic. All survivors were assessed in the neonatal period and at 1 year of age. Results Six of the 12 surviving fetuses were found to be anemic and underwent intrauterine transfusion. All fetuses survived the procedure. Four of these fetuses had normal neurological development at 1 year of age. Periventricular leukomalacia developed in one case and the patient underwent termination of pregnancy at 34 weeks. In one case delivery occurred at 34 weeks' gestation and the baby developed periventricular leukomalacia at 1 month of age. In all six non-anemic fetuses pediatric examination was normal at birth and at 1 year of age. Conclusion Intrauterine death of one monochorionic twin in TTTS puts the survivor at high risk of intrauterine death or of developing ischemic/hypoxic lesions. Our results suggest that fetal blood sampling is a useful diagnostic tool to identify those fetuses that are not anemic and hence unlikely to be at risk of developing a cerebral lesion. Copyright © 2002 International Society of Ultrasound in Obstetrics and Gynecology |
| Databáze: | OpenAIRE |
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