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At least 163 records · Page 9Linked to original sources
PubMed2002

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

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.

Blood Specimen Collection↗
PubMedDate not supplied

Umbilical cord cyst in a monochorionic twin pregnancy: an experiment of nature for the treatment of twin-twin transfusion syndrome.

A patient with a monochorionic twin pregnancy developed signs of twin-twin transfusion syndrome from 18 weeks of gestational age. At 23 weeks, an umbilical cord cyst and absent diastolic umbilical artery flow were noted in the donor twin. The pregnancy progressed uncomplicated until term and resulted in vaginal delivery of 2 healthy male babies at 38 weeks of gestational age. We hypothesize that the compression on the umbilical arteries of the donor twin by the umbilical cord cyst has resulted in a partial "compensation" of the twin-twin transfusion phenomenon.

Adult↗
PubMed1997

[Fetal hemodynamic surveillance of twin transfusion syndrome].

OBJECTIVE: To evaluate the ratio of peak systolic to least diastolic flow velocity (S/D), pulsatile index (PI) and resistance index (RI) of the umbilical arterial doppler flow at 20-40 gestational weeks in twin pregnancy for the surveillance of twin transfusion syndrome. METHODS: The fetal hemodynamics in 36 cases of twin pregnancy were monitored by Combison A-ZIPE 4871 with spectral doppler ultrasound. RESULTS: The value of S/D ratio and PI in 4 patients with twin transfusion syndrome at 32-34 weeks were significantly higher than those of normal twin (P < 0.01). Two cases of twin reversed arterial pressure (TRAP), i.e. artery to artery transfusion in one of the twin with acardius, were found at 26 and 26 + 4 weeks respectively. CONCLUSION: The S/D ratio and PI of umbilical artery might be useful indices for the surveillance of twin transfusion syndrome.

Adult↗
PubMed1978

Transfusion syndrome and the heritability of IQ.

The recent analysis of transfusion syndrome effects by Munsinger (1977) suggests that there is literally no effect of social environment on IQ variation in the population. The detailed analysis of Munsinger's report, however, indicates that his conclusions cannot be supported. Though Munsinger assigned birthweights to separated MZ twin pairs described in the literature, there do not in fact exist birthweight data for most pairs. Further, for some pairs, Munsinger also estimated their IQ's. There is no valid basis for Munsinger's claim that he has detected those separated MZ pairs within which transfusion syndrome occurred. When discussing six studies of birthweights of MZ pairs reared together, Munsinger in each case made transcription errors in selecting data from the original studies. Then he misapplied a statistical formula to the erroneous data, and concluded that inclusion of pairs with large birth-weight differences biased the IQ correlation of MZ's downwards. When Munsinger's own data base is correctly analysed, employing his own procedures, inclusion of pairs with large birthweight differences in fact increases the IQ correlation. There is thus no demonstrable basis for Munsinger's claims about transfusion syndrome and the heritability of IQ.

Birth Weight↗
PubMed2002

[Pathophysiology and therapeutic possibilities in twin-to-twin transfusion syndrome].

INTRODUCTION: Twin-to-twin transfusion syndrome is a threatening consequence of monochorionicity. Without therapeutic intervention it has approximately a 100% mortality rate, but due to therapeutic efforts it improved dramatically to about 20-50% mortality. It is caused by arteriovenosus anastomoses within the placenta, that causes hormonal changes, polyhydramnios, hypertension of the recipient and weight discordance. AIMS: Detection of ultrasonographic and pathologic consequences of twin-to-twin transfusion syndrome. PATIENTS AND METHODS: Ultrasonographic and pathologic findings of six twin pairs were analysed with the common feature of twin-to-twin transfusion syndrome. RESULTS: Ultrasonographic and pathologic results were suggestive for fetal hypertension in all recipients and pulmonary stenosis in four of them. CONCLUSION: The prognosis of twin-to-twin transfusion syndrome can be improved significantly with serial amnioreduction, amniotic fenestration, laser ablation of connecting vessels or selective fetocidium. Proper therapy prevents the development of the serious clinical and pathological consequences of twin-to-twin transfusion syndrome.

Adult↗