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- Title
TWIN-TO-TWIN TRANSFUSION SYNDROME-ASSOCIATION IN A TRIPLET PREGNANCY RESULTING IN FETAL DEMISE: A CASE REPORT.
- Authors
Marin, Diana; Mezei, Tibor-László; Burlacu, Diana
- Abstract
Introduction: Twin-to-twin transfusion syndrome (TTTS) occurs in about 10-15% of monochorionic-diamniotic multiple pregnancies, where the fetuses share a single placenta. The syndrome is a result of an unbalanced blood flow between the fetuses due to placental anastomoses. Thus one of the twins becomes the donor and the other one becomes the recipient. TTTS is often associated with twin anemia-polycythemia sequence (TAPS). The treatment of choice is fetoscopic vascular ablation. We report the case of TTTS occuring in a dichorionictriamniotic triplet pregnancy resulted in one fetal demise due to refusal of treatment at the right time. Case Report: A 33-year-old primigravida with a dichorionic-triamniotic pregnancy was presented in the Obstetrics and Gynecology Department of the County Emergency Clinical Hospital of Targu-Mures, Romania. TTTS with TAPS were ultrasonographically detected during the rutine prenatal visits in her 27 gestational week (GA). The patient was counseled regarding the risks and benefits of various available management options. Fetoscopic vascular ablation was refused by the mother. Given the extreme prematurity, a conservative approach was proposed. By the 31st GA the absence of cardiac activity was ultrasonographically detected in one of the three fetuses. Emergency cesarean section was succesfully performed. The stillborn and the shared placenta were sent to Pathology Department. The autopsy revealed a female stillborn presenting with generalized erithematous skin. Multiple autolyzed organs (stomach, pancreas and adrenal glands) were described. The morphometrical report revealed a 230x185x33 mm and 777 g placenta with 3 velamentously inserted umbilical cords measuring 19x14 mm, 140x11 mm and 76x15 mm. Microscopically, distal villous hipoplasia of the placental parenchyma corresponding to the stillborn was observed. No signs of corioamnionitis were histopathologically detected. The post-operative evolution of the mother and the 2 newborns was favorable, without any complications. Discussions : A multiple pregnancy is usually prone to severe feto-maternal risks. In case of TTTS and TAPS as associations, fetoscopic vascular ablation is the method of choice to a successful term pregnancy. Conclusions: In the reported case, where this intervention was refused, the pregnancy ended with the death of one of the fetuses, fortunately without endangering the mother or the other 2 prematurely newborns.
- Subjects
ROMANIA; MULTIPLE pregnancy; PERINATAL death; CONFERENCES &; conventions; FETOFETAL transfusion; PREGNANCY complications
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p269
- ISSN
2668-7755
- Publication type
Article