Study of maternal and perinatal outcome among twin pregnancies with one twin demise

Background: To study the incidence, management and to determine maternal and perinatal outcome in cases of twin pregnancy with one twin demise in the second half of the pregnancy.Methods: This retrospective study was carried out at Cheluvamba Hospital, a tertiary care hospital attached to Mysore medical college and research institute between September 2009 and 2014. 19 twin pregnancies complicated by single intrauterine fetal demise (IUFD) after 20 weeks of gestation were identified from the hospital records. Data collected included maternal age, parity, antenatal complications, cause of IUFD, gestational age at diagnosis, time interval between diagnosis of IUFD and delivery, mode of delivery, birth details, type of placentation and neonatal complications.Results: The incidence of twin with one twin demise was 2.056%. Mean gestational age at presentation was 33.86 weeks. Most common cause of death was growth discordance in 7 cases followed by placental insufficiency in 4 cases. 57.89% of cases had monochorionic placentation. Neonatal course was most commonly complicated by prematurity. Maternal course was uneventful in majority (63.15%) of cases with two maternal deaths due to intravascular coagulopathy sequelae.Conclusions: Single fetal death occurs more often in monochorionic twins. The main problem for the surviving twin is prematurity. It is very important to identify the chorionicity by ultrasound examination in early pregnancy and implement specific surveillance of monochorial pregnancies.

A Case of Spontaneous Twin Anemia-Polycythemia Sequence

Twin anemia-polycythemia sequence (TAPS) is characterized by the transfer of blood via intertwin vascular anastomoses in a single placenta. It differs from twin-twin transfusion syndrome (TTTS) in that amniotic fluid levels remain normal during pregnancy. Since the concept of TAPS was first introduced in 2007, some cases have been reported abroad, but no such a case has been reported in Korea. Here, we report the first case of spontaneous TAPS in Korea.

The value of ultrasonography in the differential diagnosis for TTTS and sIUGR / 安徽医科大学学报

12 patients with inconsistent growth of twins were involved.The acoustic features were analyzed,inclu-ding 2D and Doppler images.The differential diagnosis was verified during follow-up exam in some patients.8 cases were diagnosed with sIUGR by ultrasonography,meanwhile 3 were diagnosed with TTTS.The rest 1 case could not be etiologically diagnosed due to the bad image conditions.We can differentiate the two diseases by evaluating the umbilical cord insertion,the amiotic fluid and the hemodynamics of the other twin.Ultrasonography is helpful in the differential diagnosis for TTTS and sIUGR.

Twin-to-Twin Transfusion Syndrome: Diagnosis and Managements / 대한주산의학회잡지

Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies, characterized by the development of unbalanced chronic blood transfer from one twin, defined as donor twin, to the other, defined as recipient, through placental anastomoses. The incidence of TTTS in monochorionic diamniotic gestations is approximately 10% to 20%. The natural history of severe TTTS is well established with mortality approaching 80% to 100% if left untreated, especially when it presents at less than 20 weeks' gestation. This review presents overview of what is known about the pathophysiology and the diagnosis of TTTS, the markers for early detection of TTTS, treatment options available for TTTS, and complications of treatment for TTTS.

Three cases of Twin-to-Twin Transfusion Syndrome which were managed with maternal digitalization / 대한산부인과학회잡지

Twin-to-twin transfusion syndrome (TTTS) is one of the complications showing high mortality rate in monochorionic twins with vascular communication in the placenta. Clinical manifestations of TTTS are usually characterized by polyhydramnios, circulatory overload, cardiac failure and fetal hydrops in the recipient twin and symmetrical fetal growth restriction, oligohydramnios, hypovolemia and anemia in the donor twin. TTTS occurres in 10-35% of monochorionic twins. We report three cases of TTTS with fetal hydrops in which amnioreduction was serially attempted and maternal digoxin treatment was tried for the therapeutic purpose.