Secuencia TRAP: serie de casos en el Hospital Regional de Alta Especialidad de la Mujer de Tabasco / TRAP sequence: Series of cases in Hospital Regional de Alta Especialidad de la Mujer de Tabasco

Resumen OBJETIVO: Reportar, comparar y analizar el estado posnatal de pacientes con embarazo gemelar monocorial y determinar la incidencia de secuencia TRAP. MATERIALES Y MÉTODOS: Estudio retrospectivo y descriptivo de una serie de casos de pacientes con diagnóstico de embarazo múltiple monocorial atendidas entre 2014 y 2018 en el Hospital Regional de Alta Especialidad de la Mujer de Tabasco. Se incluyeron todas las pacientes con diagnóstico de secuencia de perfusión arterial reversa gemelar con finalización del embarazo y reporte del estado posnatal. Se determinó la incidencia y se excluyeron las pacientes con expedientes incompletos y embarazos no concluidos en el Hospital Regional. RESULTADOS: Se encontraron 6 casos de embarazo gemelar monocorial con secuencia TRAP. De los casos reportados, 5 fueron gemelar doble y 1 de alto orden fetal. Solo 1 de los 6 casos recibió tratamiento intraútero. En 4 casos el gemelo bomba supervivió sin complicaciones reportadas. La incidencia de secuencia TRAP de embarazos monocoriales de la muestra de estudio fue de 5.2%. CONCLUSIÓN: Se expusieron 6 casos tratados de diferentes maneras y con mejores resultados con la conducta conservadora porque en los 4 casos que no recibieron tratamiento los gemelos bomba no sufrieron descompensaciones cardiacas y supervivieron, a diferencia del único caso con tratamiento intra-útero en el que hubo complicaciones que llevaron a la terminación del embarazo en el segundo trimestre.

Abstract OBJECTIVE: Report, compare and analyze the postnatal status of patients with monochorionic twin pregnancy and determine the incidence of TRAP sequence. MATERIALS AND METHODS: A descriptive, retrospective, case series study of patients diagnosed with monochorionic multiple pregnancy attended at the High Specialty Regional Women's Hospital of Tabasco between 2014 and 2018 was carried out. The study included all patients with the diagnosis of TRAP sequence, reported postnatal outcomes and the incidence was determined. Patients with incomplete records and unfinished pregnancies were excluded. RESULTS: Six cases of twin reversed arterial perfusion were diagnosed, five of which were twin pregnancies and one was a higher order multiple pregnancy. Only one of the patients received intra-uterine treatment. The pump twin survived without complications in four of the six cases. CONCLUSION: Six treated cases were exposed in different ways and with better results with the conservative behavior because in the 4 cases that did not receive treatment, the twin pump did not suffer cardiac decompensation and survived, unlike the only case with intra-uterine treatment in which there were complications that led to termination of pregnancy in the second trimester.

Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins

OBJECTIVE: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

Prediction of Amnionicity Using the Number of Yolk Sacs in Monochorionic Multifetal Pregnancy

The purpose of this article was to evaluate the accuracy of predicting amnionicity using the number of yolk sacs by diagnostic ultrasound examination in monochorionic (MC) multifetal pregnancies between 7 + 0 and 9 + 6 gestational weeks. A total of 97 patients with MC multifetal pregnancies underwent early ultrasound examination from 2004 to 2014 at Cheil General Hospital and Women's Healthcare Center. All patients for whom the number of yolk sacs was reported were included in this study. We compared the number of yolk sacs with amnionicity confirmed by an intertwine membrane. Overall, there was a 9.3% (9 cases) discrepancy in number of yolk sacs and amnionicity (4.3% for monochorionic diamniotic, 36.4% for monochorionic monoamniotic, and 33% for monochorionic triamniotic). Among the 9 cases with discrepancies, 4 cases with 2 yolk sacs were confirmed as monoamniotic pregnancies and 4 MC twin pregnancies showing a single yolk sac were diagnosed as diamniotic twin pregnancies. One case with 2 yolk sacs was identified as a triamniotic triplet pregnancy. In 9.3% of MC gestations, the number of yolk sacs was not correlated with the number of amnions in our study. To determine amnionicity in MC multifetal pregnancies, we recommend careful evaluation not of the number of yolk sacs but the presence or absence of intertwine dividing membrane after 8 gestational weeks.

Monochorionic diamniotic twin pregnancy with selective IUGR type 2: fetoscopic and sonographic findings of ominous prognosis / Gestación gemelar monocorial complicada con RCIU selectiva tipo 2: hallazgos ecográficos y fetoscópicos de mal pronóstico

A woman with a monochorionic diamniotic twin pregnancy was referred to our Centre due to a discrepancy in size between the foetuses. She was 17 weeks' pregnant when the diagnosis of selective IUGR type 2 was made and the laser ablation of the placental anastomoses was performed. During the fetoscopy, we identified an arterio-venous anastomosis with bidirectional flow, which is atypical in this type of anastomoses (unidirectionals) and could represent a sign of ominous prognosis for the restricted twin.

Presentamos el caso de una gestante de 17 semanas con una gestación gemelar monocoriónica biamniótica complicada con RCIU selectivo tipo 2 que requirió, de acuerdo a criterios ecográficos, ablación quirúrgica láser de las anastomosis placentarias. Se identificó durante la fetoscopia una anastomosis arterio-venosa que mostraba flujo bidireccional lo cual es sumamente inusual en este tipo de anastomosis, no reportado antes en la literatura, constituyendo así un signo de mal pronóstico para el gemelo pequeño.

Angioarquitectura placentaria y los orígenes de la patología monocorial

Los gemelos coriangiopagos (fetos que comparten una placenta) pueden tener de manera exclusiva asimetría en la distribución de territorios placentarios, con alta incidencia de inserción marginal y algunas veces en velamento del cordón umbilical; además, transfusiones interfetales (agudas o crónicas) que se producen por la presencia de comunicaciones sanguíneas (anastomosis placentarias). Resulta así una serie de fenotipos fetales que solo se presentan en este tipo de embarazos, en orden de frecuencia, el síndrome de transfusión feto-fetal, restricción del crecimiento intrauterino selectivo, síndrome de anemia-policitemia y la secuencia arterial reversa (twin reversed arterial perfusion- TRAP), pudiendo coexistir más de uno en un mismo embarazo. Es importante entonces el estudio de la angioarquitectura placentaria en los gemelos monocoriónicos, para comprender el comportamiento y el fenotipo que resultara en cada embarazo.

Chorio-angiopagus twins (fetuses sharing one placenta) may exclusively show asymmetry in the distribution of placental territories with high incidence of marginal insertion and sometimes velamentous placenta as well as twin-twin transfusion (acute or chronic) produced by vessel communications (placental anastomosis). A series of fetal phenotypes may result including twin-to-twin transfusion syndrome, selective intrauterine growth restriction, anemia-polycythemia syndrome, and twin reversed arterial perfusion - TRAP- sequence; they may coexist. It is therefore important to study placental angioarchitecture in monochorionic twins in order to understand resulting both outcome and phenotype.

Fetoscopia y coagulación bipolar selectiva en una gestación gemelar complicada con secuencia arterial reversa: a propósito del primer caso en el Perú

Se presenta el caso de una gestante de 27 semanas de edad gestacional referida a nuestro servicio por presentar una gestación gemelar monocoriónica complicada con secuencia arterial reversa (TRAP). Se realizó una intervención de fetoscopia y coagulación bipolar del gemelo acárdico, con un resultado favorable.

A case of a pregnant woman referred to our center at 27 weeks of gestational age for twin reversed arterial perfusion (TRAP) sequence is reported. Fetoscopy and bipolar coagulation of the umbilical cord of the acardiac twin was performed with successful outcome.

Manejo laparoscópico de embarazo ectópico en cicatriz uterina por cesárea previa: reporte de un caso

El embarazo ectópico es la gestación que se anida fuera del endometrio que recubre la cavidad uterina. Se estima una incidencia de 0,94 a 2,6% de todas las gestaciones. Su localización en cicatriz uterina de cesárea previa (0,15%) -una rara presentación de esta patología- representa 6,15% de los casos de embarazo ectópico que ocurren en mujeres con antecedente de cesárea. En el presente artículo se analiza el caso de una paciente de 28 años, gesta 5, para 0412, con antecedente de 3 cesáreas, que acudió al Hospital Nacional Docente Materno Infantil (HONADOMANI) San Bartolomé en febrero 2013 con diagnóstico de embarazo ectópico localizado en cicatriz uterina por cesárea previa, por ecografía transvaginal, y que fue resuelto exitosamente mediante manejo laparoscópico. El embarazo ectópico localizado en la zona de cicatriz uterina por cesárea previa, aunque raro, va en aumento debido al incremento de la tasa de cesáreas. La ultrasonografía transvaginal es crucial para su diagnóstico, y actualmente no existe un consenso o guía clínica que nos oriente en su manejo.

Ectopic pregnancy is a gestation that nests outside of the uterus endometrial lining. Incidence is estimated at 0.94-2.6% of all pregnancies. Its location in a previous cesarean section uterine scar is a rare (0.15%) presentation of this disease, accounting for 6.15% of ectopic pregnancy cases occurring in women with previous cesarean section. A case of a 28 year-old woman G: 5 P: 0412, with history of 3 cesarean sections was hospitalized in Hospital Nacional Docente Materno Infantil (HONADOMANI) San Bartolomé in February 2013 because of transvaginal ultrasound diagnosis of ectopic pregnancy located in previous uterine cesarean scar; it was successfully resolved by laparoscopic management. Cases of ectopic pregnancy located in the uterine scar from previous cesarean are increasing due to the rising cesarean section rate. Transvaginal ultrasonography is crucial for diagnosis. There is no current consensus or guidelines for its management.

Parasitic acardiac twin: a rare anomaly of monochorionic TRAP sequence.

Acardiac twin is a rare complication of monozygotic multiple pregnancy. Vascular anastomosis between twins, with single placenta leads to transfer of deoxygenated blood from umbilical artery of donor to the recipient twin in reverse direction through its umbilical artery which is responsible for abnormal growth. Acardiac twin dies in utero or immediately after birth with a 50-75% mortality of normal donor twin due to congestive heart failure secondary to strain of perfusing acardiac twin.

A Case Report of Heterokaryotypic Monochorionic Twin Pregnancy with Discordant for Turner Syndrome / 대한주산의학회잡지

Monochorionic twins with discordant karyotypes are rare and mostly caused by post-zygotic mitotic nondisjunction. A 32 year old nulliparous woman at 11 weeks of gestation with spontaneous twin pregnancy was referred to our hospital. An amniocentesis was performed in both amniotic sacs at 15 weeks of pregnancy. One fetus in monochorionic twin pregnancy was diagnosed with Turner syndrome with cystic hygroma, and the other fetus was normal. Because of high mortality rate in abnormal fetuses, the umbilical cord coagulation was performed using radiofrequency ablation to prevent the damage of co-twin that may be caused by the demise of one fetus. After delivery, chorionicity of placenta was ascertained by pathologic exam. Postnatal findings of physical exam, abdominal and brain sonography were normal in the surviving neonate.

Secuencia de perfusión arterial reversa en embarazo gemelar (TRAP) monocoriónico con feto acárdico

La secuencia síndrome de perfusión arterial reversa (TRAP, por sus siglas en inglés) es una de las patologías asociadas a las complicaciones del embarazo gemelar monocoriónico, que puede mostrar discordancia del volumen de líquido amniótico entre los fetos y hasta coexistencia de un feto acárdico con uno sano. Se comunica el caso de un síndrome de perfusión arterial reversa TRAP diagnosticado en el segundo trimestre del embarazo y se discute el manejo realizado en el servicio, así como los resultados perinatales asociados.

Twin reverse arterial perfusion (TRAP) sequence is a pathology associated to monochorionic twin pregnancy complications that may show amniotic fluid volume discordance between fetuses and even coexistence of one acardiac fetus and one healthy fetus. A TRAP case diagnosed in the second trimester of pregnancy is reported and treatment and perinatal results are discussed.

Síndrome de transfusão feto-fetal, diagnóstico e tratamento: relato de caso / Twin-twin transfusion syndrome, diagnosis and treatment: case report

Objetivo: relatar um caso de síndrome de transfusão feto-fetal (STFF), demonstrando a importância do correto eprecoce diagnóstico ultrassonográfico e quando necessário a indicação da fotocoagulação a laser fetoscópica(FCLF) como melhor conduta terapêutica. Relato do caso: mulher 18 anos, secundigesta, gestação gemelarmonocoriônica diamniótica com diagnóstico ultrassonográfico tardio de STFF, devido não realização de prénatal.Realizados dois procedimentos de amniodrenagem como medida paliativa, evoluindo para partoprematuro no oitavo dia de internação. Um dos gêmeos evoluiu a óbito na UTI neonatal. Considerações finais:percebe-se a necessidade de uma melhor assistência pré-natal, treinamento dos profissionais médicos para arealização do diagnóstico ultrassonográfico correto e de investimentos em centros de Medicina fetal no Parápara tratamento adequado

Objective: to report a case of twin-twin transfusion syndrome (TTTS), demonstrating the importance of correctand early ultrasound diagnosis and when necessary the indication of laser photocoagulation fetoscópica (FCLF)as the best therapeutic approach. Case report: 18 years woman, in her second, diamniótica monochorionic twinpregnancy with late diagnosis of TTTS, because failure to carry out prenatal care. Evolved into premature laborafter cesarean with indication of two procedures amniodrenagem. After a cesarean section withoutcomplications was death of the twins in the NICU. Final considerations: we perceive the need to support theadequacy of prenatal care, training of medical professionals to perform the correct ultrasound diagnosis andinvestments in fetal medicine centers in Pará.

Nursing of patients with monochorionic twins undergoing selective feticide with bipolar electrocoagulation / 中国实用护理杂志

Objective To summarize the key nursing points in patients with monochorionic twins undergoing selective feticide with bipolar electrocoagulation.Methods Selective feticide with bipolar electrocoagulation were performed in 68 monochorionic twins with one twin anomaly.And the perioperative care was performed on the patients.Results Operations were accomplished successfully in 68 cases.No complications,such as infections,premature rupture of membrane and so on,were found in all cases seven days after operation.Conclusions The nursing key points include preoperative psychological nursing by interpretation of the operations,monitoring fetal heart sounds during operations,and close observation of body temperature,uterine contractions and fetal heart rate in pregnant women after operations.Careful perioperative nursing is helpful for improvement of operative success and to ensure normal development of fetus.

Resultados actualizados en el tratamiento por fetoscopía del síndrome de transfusión feto fetal en Clínica Alemana de Santiago / Results in fetoscopy-guided treatment of twin to twin transfusion syndrome in Clinica Alemana

Twin to twin transfusion syndrome diagnosed before 26 weeks has 90 percent mortality and occurs in 15 percent of monochorionic twin pregnancies. Treatment is complex as a screening program, referral, complex surgical procedure and specialized perinatal care are required. The objective is to report the recent results in fetoscopy-guided treatment of TTTS cases in Clínica Alemana. Results: 18 new cases were treated in the latest 2 years, in a series of 36 cases from 2005. Survival of one or both twins was 72.8 percent in the first 18 cases, and 77.8 percent in the latest 18 cases. The number of cases with both survivors increased from 5/18 to 7/18. Conclusions: The outcome was similar to that reported from international series. The results are better in the later cases, according to the increasing experience in our center.

Antecedentes: El Síndrome de Transfusión Feto Fetal (STFF) diagnosticado antes de las 26 semanas tiene una mortalidad de 90 por ciento y se afecta el 15 por ciento de los gemelares monocoriales. El manejo es complejo dado que requiere un proceso de diagnostico en los centros de atención, un proceso de derivación, la cirugía y el manejo perinatal especializado posterior. Objetivo: Actualizar el resultado del tratamiento por fetoscopía en Clínica Alemana de Santiago (CAS) en los casos recientemente tratados. Resultados: Desde 2005 hasta la fecha se han tratado 36 casos con sus embarazos resueltos. La sobrevida de al menos un feto fue 77,8 por ciento en los últimos 18 casos, mostrando una mejora en relación a los primeros (72,8 por ciento). El número de embarazos con ambos fetos vivos aumento de 5 a 7. Conclusiones: El resultado materno-perinatal es similar a las series internacionales y muestran una mejora progresiva en la sobrevida en la serie tratada. Los resultados favorables se mantienen a largo plazo y se consolidan en beneficio de las pacientes.

A case of acardiac twin pregnancy with fetus survival after successful radiofrequency ablation of umbilical cord / 대한산부인과학회지

Acardiac twin is a rare anomaly that occurs 1% in monochorionic twins and 1 in 35,000 pregnancies overall. Acardiac twin, also known as twin-reversed arterial perfusion (TRAP) sequence, involves a "pump" or donor twin perfusing a recipient or "acardiac" twin through vascular (usually arterial-arterial and venous-venous) anastomoses. Perinatal mortality rate for the pump twin has been reported to be 50~75%, mainly as a result of polyhydramnios, preterm labor, and congestive heart failure. Therefore, occlusion of the circulation to the acardiac twin has been recommended to improve perinatal outcome of the pump twin. Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. We report our experience in the treatment of patients with TRAP sequence using radio frequency ablation to stop perfusion to the acardiac twin.

Gestación gemelar monocorial: Ecografía, Doppler y estudio de los vasos placentarios post parto y su correlación con la ocurrencia de complicaciones / Monochorionic twin gestations: Ultrasonography, Doppler and study of the placental vassels post parturition and his correlation with the occurrence of complications

Propósito: Evaluar la correlación entre la ocurrencia de Restricción al Crecimiento Intrauterino (RCIU), RCIU selectivo (RCIUs) y Síndrome de Transfusión Feto-Fetal (STFF) y las características de la placenta en la gestación doble monocorial (GDM). Estimar cuál es la importancia de los hallazgos ecográficos y Doppler. Material y métodos: Entre enero del 2005 y enero de 2008 fueron evaluados 8 GDM. La corionicidad fue determinada con ecografía en el 1º trimestre. Se realizaron seguimientos ecográficos evaluando cantidad de líquido amniótico, vejiga, peso fetal y Doppler de vasos fetales. Al nacimiento se tiñeron los vasos placentarios con colorantes no vitales y se evaluó la presencia y tipo de anastomosis, la distribución de los territorios y la calidad de inserción del cordón umbilical (CU) sea central (C), marginal (M) o velamentosa (V). Resultados: Seguimiento ecográfico: discrepancia de peso > 25% (RCIUs) (n=3); peso de ambos fetos ≤ percentil 3 (RCIU) (n=1); signo ecográfico de STFF (n=1); normales (n=3). Seguimiento con Doppler: Flujo Ausente/Reverso intermitente (FA/Ri) en arteria umbilical (AU) (n=4); signos de insuficiencia placentaria en AU (n=3); normales (n=2). Complicaciones perinatales evaluadas: STFF (n=1); RCIUs (n=2); RCIU (n=1); ninguna (n=4). Territorios placentarios: distribución igual (n=6); distribución desigual (n=2). Inserción del CU: ambos M (n=3); ambos C (n=2); una C y otra M(n=2); una M y otra V (n=1). Anastomosis vasculares: presencia de anastomosis arterio-arteriales (AAA) y anastomosis arterio-venosas (AAV) en ambas direcciones (n=6); presencia de AAA y AAV en una dirección (n=1); presencia de AAV en una dirección sin AAA(n=1). El STFF se relacionó con ausencia de AAA y presencia de AV en una dirección. Los signos de insuficiencia placentaria en AU se dieron en los casos de RCIU. Los 2 RCIUs presentaron desigual distribución del territorio placentario. Conclusión: Las anastomosis vasculares están presentes en todas las GDM. Las anomalías de inserción del CU son frecuentes en GDM. En la GDM el RCIUs se relaciona con distribución desigual del territorio placentario. La presencia de FA/Ri en la AU de un feto sugiere la presencia de AAA, las que impedirían un STFF.

Objective: To correlate between the appearence of Intrauterine Fetal Growth Restriction (IFGR), Selective Intrauterine Fetal Growth Restriction (SIFGR), Twin-to-Twin Transfusion Syndrome (TTTS) and macroscopic findings of placentas in Monochorionic Twin Gestations. To determine the importance of ultrasound and Doppler findings. Materials and methods: Between January 2005 and January 2008 we diagnosed 8 monochorionic twin pregnancies. Chorionicity was determined with first trimester ultrasound screening. Follow-up scans were done to assess amniotic fluid volume, bladders, fetal weight and fetal Doppler ultrasound. Alter delivery, we cannulated and dyed umbilical arteries and veins in order to characterise vascular anastomoses. We also evaluated distribution of the placenta plate, and type of cord insertion (central, marginal or velamentous). Results: Follow-up scans revealed: 3 cases with selective intrauterine fetal growth restriction (SIFGR); 1 case with intrauterine fetal growth restriction (IFGR); 1 case with twin-to-twin transfusion syndrome (TTTS); and 3 normal pregnancies. Follow-up Doppler scans revealed: 4 cases with intermittent absent/reversed end-diastolic umbilical artery flow; 3 cases with signs of placental insufficiency; and 2 normal cases. Perinatal outcome: 1 case of twin-to-twin transfusion syndrome (TTTS); 2 cases of selective intrauterine fetal growth restriction (SIFGR); 1 case of intrauterine fetal growth restriction (IFGR); 4 healthy cases. Visual inspection of placental plate: equal placental sharing (6 cases); unequal placental sharing (2 cases). Types of cord insertion: both fetuses with marginal cord insertion (3 cases); both fetuses with central insertion (2 cases); one fetus with central and the other one with marginal insertion (2 cases); one fetus with marginal insertion and the other one with velamentous insertion (1 case). Vascular anastomoses: 6 cases presented arterio-arterial ansatomoses (AAA) and arterio-venous anastomoses (AVA) in both directions; 1 case showed AAA and AVA in only one direction; another case showed AVA in one direction without AAA. The only case of TTTS was related to the presence of AVA in one direction and the absence of AAA. Signs of placental insufficiency were seen in the case of intrauterine fetal growth restriction (IFGR). Both cases of SIFGR showed unequal placental distribution. Conclusions: Vascular anastomoses are present in all cases of monochorionic twin gestations. anomalies in the cord insertion are frequent in this type of pregnancies. Selective intrauterine fetal growth restriction is related to unequal distribution of the placental plate. Intermittent absent/reversed end-diastolic umbilical artery flow in one of the fetuses suggests there are arterioarterial anastomoses, which are supposed to protect against twin-to-twin transfusion syndrome.

Perinatal outcomes according To chorionicity in Twin Gestations

PURPOSE: The purpose of this study was to assess the natural history and perinatal outcomes of twin gestations according to chorionicity. METHODS: We retrospectively reviewed the medical records of 99 monochorionic (MC) and 206 dichorionic (DC) twin gestations delivered at Il Sin Christian Hospital in Busan between January 2002 and December 2007. The incidences of twin-to-twin transfusion syndrome (TTS) and selective intrauterine growth restriction (sIUGR), as well as perinatal morbidity and mortality, were evaluated. RESULTS: MC twins had a lower gestational age (35.7 vs. 36.6 weeks, P=0.03) at birth and a higher incidence of intrauterine fetal loss (10% vs. 1.5%, P<0.001) than DC twins. The incidence of intrauterine fetal loss was higher in MC sIUGR than in DC sIUGR (19% vs. 2.5%, P=0.025) twins. The number of admissions to the neonatal intensive care unit (NICU; 31% vs. 16%, P=0.042), and the incidence of periventricular leukomalacia (7% vs. 0%, P=0.031), and respiratory distress syndrome with surfactant treatment (27% vs. 11%, P=0.049) were higher in MC than DC twins. The incidences of sIUGR and TTS were 21 and 9% among the MC twins. The incidences of intrauterine fetal loss were higher in MC twins with TTS [6 of 9 (67%)] or sIUGR [4 of 21 (19%)] than uncomplicated MC twins (P<0.001). The frequency of admission to the NICU (P=0.001), the length of hospital stay (P=0.033), the prevalence of periventricular leukomalacia (P=0.011), and intraventricular hemorrhage (P=0.007) were also higher in MC with TTS or sIUGR than in uncomplicated MC twins. CONCLUSION: The incidence of neonatal complications was higher in MC twins, especially those gestations complicated by TTS or sIUGR.

Retrospective analysis of fetoscopic photocoagulation of communicating placental vessels of twin-twin transfusion syndrome / 第三军医大学学报

Objective To investigate the effect of fetoscopic photocoagulation of communicating placental vessels in twin-twin transfusion syndrome(TTTS)(selective or non-selective) on the perinatal outcomes.Methods Six cases of TTTS admitted in our department from Dec.2006 to Jun.2008 underwent fetoscopic photocoagulation of communicating vessels.Under direct real-time sonographic guidance,a 3-mm-diameter fetoscope was percutaneously inserted through the maternal abdominal wall into the amniotic cavity of the recipient twin.A combination of ultrasonographic and fetoscopic vision was used to identify the crossing vessels which were systematically coagulated using Nd:YAG laser fiber or bipolar electrocoagulation.Results All the 6 mothers tolerated the procedure without major complications.Two fetal survival rate was 33.33%.Conclusion Fetoscopic photocoagulation of communicating placental vessels in TTTS can effectively improve perinatal outcomes.

A case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome / 대한산부인과학회잡지

Nearly 100% of monochorionic twin pregnancies have vascular anastomoses and a fourth of those has clinical features of twin-to-twin transfusion syndrome. Cerebral palsy, microcephaly, porencephaly, and multicystic periventricular leukomalacia are serious antenatal neurologic complications associated with vascular communications in monochorionic twin gestation. It is most likely that such neurological damage is caused by intrauterine cerebral ischemic necrosis. The intermittent blood flow reversal or sudden hypotension in one twin, or emboli of thromboplastic material originating in the dead fetus could cause in utero cerebral damage in the other twin. In this report, we present a case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome.