Cases reported "Diseases in Twins"

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1/3. term birth after midtrimester hysterotomy and selective delivery of an acardiac twin.

    OBJECTIVE: Our aim was to determine whether hysterotomy and selective removal of an acardiac twin could improve the outcome of the "pump" twin. STUDY DESIGN: A literature and case review of the outcome of the acardiac twin malformation was performed. When an acardiac malformation was diagnosed at 19 weeks' gestation the patient was monitored with weekly ultrasonographic examinations. At 23 weeks' gestation, no blood flow could be demonstrated to the acardiac twin and it was thought that the continued presence of the acardiac twin posed a risk to the "pump" twin. A midtrimester hysterotomy was performed and the acardiac twin was delivered. RESULTS: After the midtrimester hysterotomy, the pregnancy progressed to term and a healthy female infant was delivered by elective cesarean section at 37 weeks' gestation. CONCLUSION: Midtrimester hysterotomy may be a useful intervention in cases of twinning when one fetus is a threat to the health of the other.
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ranking = 1
keywords = hysterotomy
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2/3. Twin-reversed arterial perfusion (TRAP) sequence: case reports and review of literature.

    The twin reversed-arterial-perfusion (TRAP) sequence found in monozygotic twins is a consequence of primary or secondary cardiac development disruption and direct arterioarterial and venovenous placental anastomoses. Associated findings include the presence of a single umbilical artery (66%) and chromosomal abnormalities in the acardiac twin (33%). Morphological abnormalities in the acardiac twin are consistent with perfusion of tissues supplied by the common iliac and lower branches of the aorta with deoxygenated blood. The pump or donor twin may develop cardiac failure because of the anomalous perfusion circuit. polyhydramnios is significantly associated with presence of renal tissue in the acardiac twin. An acardiac pump twin weight ratio (> 50%) is associated with the development of polyhydramnios and preterm labour. Identified high-risk factors for poor obstetrical outcome include: acardiac anceps, polyhydramnios, acardiac twin with ears, and pump twin cardiac failure. Management options include elective termination, observation (serial cardiotocography (CTG), ultrasonography and echocardiography) and selective nonsurgical interventions (indomethacin, digitalis, tocolysis). Additionally, surgical interventions (hysterotomy with selective delivery of the acardiac twin or ligation of the acardiac twin's umbilical cord), and ultrasound-guided embolization of the acardiac twin's umbilical artery with absolute alcohol, platinum coils, or thrombogenic coils have been reported. The most appropriate interventions for the various clinical presentations of this disorder are as yet undetermined, and conservative nonintervention is often appropriate. Long-term follow-up data on surviving pump twins are lacking. It is anticipated that centres with active study protocols for these conditions will best serve patient care and clinical research needs.
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ranking = 0.125
keywords = hysterotomy
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3/3. Selective delivery in a twin gestation.

    One or more infants of a multifetal pregnancy occasionally require delivery selectively because of in utero risk of fetal death in circumstances in which the sibling fetus appears well. At 26 weeks 5 days of gestation a small fundally placed twin in a dichorionic gestation had an estimated fetal weight of 650 g with decreased amniotic fluid and ominous Doppler velocity findings in his umbilical artery. A normally grown presenting sibling had reassuring fetal surveillance data. Over a 2-week interval the growth-restricted twin showed no growth, and his status deteriorated. He was selectively delivered by hysterotomy. Selective delivery may offer parents of multifetal gestations an additional option when 1 or more of their fetuses are at high risk for in utero death.
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ranking = 0.125
keywords = hysterotomy
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