Cases reported "Fetofetal Transfusion"

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1/27. Rapid development of hydrops fetalis in the donor twin following death of the recipient twin in twin-twin transfusion syndrome.

    Intrauterine death of one fetus in monochorionic twinning is associated with high rates of perinatal morbidity and mortality in the surviving fetus. Subsequent development of hydrops fetalis in the donor twin after fetal demise of the recipient twin has been described in only two case reports and pathophysiology remains unclear. We report on a monochorionic-diamniotic twin pregnancy complicated by severe twin-twin transfusion syndrome. Ultrasound examination at 20 weeks of gestation showed discrepant twins with oligohydramnios in the smaller twins' sac and polyhydramnios in that of the larger twin. Repeated amniocenteses permitted prolongation of the pregnancy. However, the recipient twin developed deteriorating hydrops fetalis and died at 28 weeks of gestation. After this event, subsequent development of hydrops fetalis in the surviving donor twin could be observed, as well as an increase of amniotic fluid. An elective cesarean section was performed at 29 weeks of gestation. Initial hypoxemia could be effectively treated by high frequency oscillatory ventilation, surfactant therapy and inotropic support. The infant was discharged in good condition at the age of 2 months. Although rare, antenatal demise of the recipient twin in a monochorionic pregnancy can be associated with the subsequent development of hydrops fetalis in the surviving donor twin. We speculate that this phenomenon is due to ischemia-reperfusion injury of the previously poorly perfused twin.
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ranking = 1
keywords = mortality
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2/27. Maternal and neonatal outcome in a monochorionic twin pregnancy complicated by single intrauterine demise.

    Single fetal death in monochorionic pregnancies is believed to be associated with increased risk of perinatal morbidity and mortality for the living twin and risk of coagulopathy affecting the mother. In this report we present a case of single intrauterine death in a monochorionic twin gestation diagnosed in the 28th week of pregnancy.
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keywords = mortality
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3/27. Twin-twin transfusion syndrome: the 'Select' procedure.

    OBJECTIVES: Twin-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal morbidity and mortality. The condition results from intertwin vascular connections in the shared placenta. We report here a case of early, severe TTTS that failed to respond to serial amniocenteses and that was successfully treated by means of superselective laser coagulation. methods: A causative arteriovenous anastomosis was identified by means of prenatal obstetrical sonography, using color and spectral Doppler techniques. At fetoscopy, performed at 23 weeks' gestation, laser occlusion of only this connection was achieved. RESULTS: This therapeutic intervention resulted in rapid resolution of all evidence of TTTS and a successful pregnancy outcome, with subsequent delivery of 2 healthy infants at 33 weeks' gestation. CONCLUSIONS: The potentially fatal pathophysiology of TTTS was reversed by interruption of a single arteriovenous connection. We have termed this the sonographically evaluated, laser-endoscopic coagulation for twins ('Select') procedure.
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keywords = mortality
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4/27. Use of continuous fluid drainage for severe polyhydramnios due to twin to twin transfusion syndrome.

    Acute polyhydramnios due to twin to twin transfusion is a rare complication of twin pregnancies which, despite treatment, has a high perinatal mortality. Repeated decompression amniocentesis has been used but is associated with certain risks. We report the use of continuous, gradual fluid drainage as an alternative method of uterine decompression.
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ranking = 3492.8238698573
keywords = perinatal mortality, mortality
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5/27. Increased nuchal translucency and pathological ductus venosus flow: two cases of TRAP sequence with different outcomes.

    Twin reversed arterial perfusion (TRAP) sequence develops in 1% of monozygotic twins. One normal twin (donor) provides circulation for itself and for a more or less incomplete twin (recipient) with a high incidence of mortality in the donor twin. However, if the condition is detected and treated early, one twin or two triplets may survive. The study of TRAP sequence helps to better understand the pathophysiological pathways of this condition. We present two cases of TRAP sequence seen in our center with different courses. In these cases the increased nuchal translucency thickness and the pathological ductus venosus flow pattern may have been prognostic of the pregnancy outcome.
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ranking = 1
keywords = mortality
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6/27. Successful outcome after serial amnioreductions in triplet fetofetal transfusion syndrome.

    BACKGROUND: Triplet fetofetal transfusion is an extremely rare complication with high perinatal mortality. Its rarity does not allow any prospective randomized study on various interventional methods to be conducted. CASE: We report one case of triplet fetofetal transfusion syndrome with survival of all three fetuses. Two were donor fetuses, and one was the recipient fetus. Serial amnioreductions were performed at 22, 24, and 26 weeks' gestation to relieve symptomatic polyhydramnios. Premature rupture of membranes occurred at 27 weeks and cesarean delivery was performed. All three babies were discharged home by 4 months of age, and all had normal neurological development when assessed at 6 months of age. CONCLUSION: The option of serial amnioreduction, with the anticipation and preparation for delivery at around 28 weeks, should be seriously considered when triplet fetofetal transfusion syndrome is encountered.
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ranking = 3492.8238698573
keywords = perinatal mortality, mortality
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7/27. Spontaneous cessation of umbilical blood flow in the acardiac fetus of a twin pregnancy.

    The acardiac fetus is a rare entity found only in monozygotic multiple pregnancy. Although the acardiac fetus is non-viable, the perinatal mortality rate for the normal fetus may be as high as 50 per cent, and is usually associated with fetal heart failure and hydrops fetalis, or as the result of prematurity. In this communication, we describe a case of spontaneous cessation of blood flow to an acardiac fetus and discuss the management of this condition with special reference to optimizing the outcome for the normal fetus.
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ranking = 3492.8238698573
keywords = perinatal mortality, mortality
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8/27. Poor long-term outcome in a survivor presenting with the twin reversed arterial perfusion sequence in utero: a case report.

    The twin reversed arterial perfusion (TRAP) sequence is a very rare complication of multiple gestations and is associated with a high mortality rate, reaching more than 50% in pump twins. The four common complications are preterm labor, polyhydramnios, fetal congestive heart failure, and fetal death of the pump twin in utero. prenatal diagnosis during early pregnancy is possible using detailed ultrasonographic examination. Therapies, including conservative treatment and invasive procedures, are directed toward achieving optimal maintenance of pump twins based on clinical presentation. risk factors for pump twin mortality include a high twin-to-twin weight ratio, acardiacus anceps, low umbilical artery pulsatility index, and a rapid growth rate in the acardiac twin. Herein, we present a case of TRAP sequence in a patient who underwent conservative treatment and had a poor neurologic outcome during long-term follow-up. Although the experience is still limited, early diagnosis of TRAP sequence and more aggressive treatment, instead of an expectant approach, might be a better option.
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ranking = 2
keywords = mortality
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9/27. Percutaneous ultrasonographically guided ablation of an acardiac twin.

    Acardiac twinning is caused by twin reversed arterial perfusion (TRAP). Normal "pump" twins may face early delivery and cardiac decompensation and have a high perinatal mortality. A primagravid patient had serial evaluation of a TRAP pregnancy beginning early in the second trimester. Rapid growth of the acardiac sibling, high diastolic velocity Doppler waveforms in the perfusing vessel, and early hydramnios prompted ablation of blood flow by a percutaneous ultrasonographically guided infusion of absolute alcohol. A term birth of a normal pump twin was the outcome. Ablation of blood flow into an acardiac sibling of a TRAP pregnancy may be indicated in cases with a poor prognosis by use of an effective percutaneous ultrasonographically guided technique.
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ranking = 3492.8238698573
keywords = perinatal mortality, mortality
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10/27. A case of TRAP sequence: acardiac twin.

    Monochorionic twinning contributes significantly to neonatal morbidity and mortality. The twin-twin transfusion syndrome complicates 5-35% of monozygotic twin pregnancies with monochorionic placentation. The most severe and a rare manifestation of this condition is acardiac twinning which is seen in 1 in 35,000 pregnancies. The acronym TRAP (Twin Reversed Arterial Perfusion) sequence is used to describe this condition. The acardiac twin does not survive while the mortality for the normal twin is about 50%. Proper timing of the delivery is of prime importance to survival of the normal fetus for which emphasis is placed on close sonographic monitoring for early antenatal diagnosis. We present such a case of TRAP sequence because of its rarity.
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ranking = 2
keywords = mortality
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