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Combined interstitial laser cauterisation of placental anastomosis and intrauterine intracardiac transfusion following monochorionic co-twin demise: a case report

Hong Kong medical journal = Xianggang yi xue za zhi, 2021-08, Vol.27 (4), p.293 [Peer Reviewed Journal]

2021. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 1024-2708 ;EISSN: 2226-8707 ;DOI: 10.12809/hkmj208806 ;PMID: 34413258

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  • Title:
    Combined interstitial laser cauterisation of placental anastomosis and intrauterine intracardiac transfusion following monochorionic co-twin demise: a case report
  • Author: Hui, P W ; Seto, M T Y ; Cheung, K W
  • Subjects: Ablation ; Anastomosis, Surgical ; Anemia ; Ascites ; Cardiac arrhythmia ; Cautery ; Edema ; Female ; Fetuses ; Hemoglobin ; Humans ; Intervention ; Laparotomy ; Laser Therapy ; Lasers ; Miscarriage ; Placenta ; Pregnancy ; Twins, Monozygotic ; Ultrasonic imaging ; Veins & arteries
  • Is Part Of: Hong Kong medical journal = Xianggang yi xue za zhi, 2021-08, Vol.27 (4), p.293
  • Description: Discussion Single twin demise occurs in monochorionic pregnancies with twin-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction but may also occur unexpectedly in pregnancies with no obvious complications.1 Feto-fetal haemorrhage through the placenta anastomosis leads to acute hypovolaemia and results in fetal anaemia, cerebral damage or death of the co-twin.1 2 Bowel and renal complications have also been reported.3 4 The present case illustrates successful intervention with a combination of interstitial laser to a placental anastomosis and intracardiac transfusion for a fetus at 15 weeks of gestation following monochorionic co-twin demise. Neurological damage affects almost 20% of co-twin survivors especially in fetuses demonstrating signs of fetal anaemia.1 6 This can be assessed by measuring MCA PSV.7 A value [greater than]1.55 MoM is suggested to be associated with a fivefold increase in the relative risk of cerebral injury.1 Rescue intrauterine transfusion has been proposed for an anaemic monochorionic survivor.8The optimal timing of transfusion and impact on overall long-term outcome remain debatable. The energy requirement was guided by generation of an echogenic area around the fibre tip encompassing the vessel and cessation of blood flow on Doppler ultrasound. Evidence of transient cardiac failure has been reported after single fetal death in monochorionic twins and immediate intrauterine transfusion has been advocated to restore the circulatory volume.2 This case did not have features of TTTS although ascites, cardiomegaly, and tricuspid regurgitation were noted after co-twin demise and before intrauterine intervention.
  • Publisher: China: Hong Kong Academy of Medicine
  • Language: English;Chinese
  • Identifier: ISSN: 1024-2708
    EISSN: 2226-8707
    DOI: 10.12809/hkmj208806
    PMID: 34413258
  • Source: Open Access: DOAJ Directory of Open Access Journals
    AUTh Library subscriptions: ProQuest Central
    GFMER Free Medical Journals
    MEDLINE
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