Management of a case of twin-to-twin transfusion syndrome by a combined surgical approach.

Abstract:

OBJECTIVE:The management of a case of severe twin-to-twin transfusion syndrome at 24 weeks of gestation is presented, using a combined surgical and medical approach. METHODS:Operative fetoscopy was used to coagulate placental vessels crossing the intertwin membranes. Repeated intrauterine transfusions were used to correct recurrent anemia in the donor twin. Selective three-dimensional placental angiography and directed histological analysis were used to study the placenta after delivery. RESULTS:Resolution of twin-to-twin transfusion syndrome was obtained by coagulation of placental anastomoses, but was followed by recurrent anemia in the donor twin. This was successfully treated by serial intrauterine blood transfusions, and 2 healthy twins were delivered at 31 weeks of gestation. One artery-to-vein anastomosis was demonstrated to be the only communication left between the two circulations. CONCLUSIONS:This case illustrates the limitations of placental surgery in twin-to-twin transfusion syndrome and highlights the need for ultrasound and Doppler follow-up of these high-risk fetuses to indicate further treatment. Placental anastomoses can be overlooked by macroscopic examination and injection technique, but can be demonstrated by placental angiography.

journal_name

Fetal Diagn Ther

authors

Van Peborgh P,Pelletier G,Suarez B,Ville Y

doi

10.1159/000020809

subject

Has Abstract

pub_date

1998-03-01 00:00:00

pages

75-8

issue

2

eissn

1015-3837

issn

1421-9964

pii

fdt13075

journal_volume

13

pub_type

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