Fetal Surgery in Monochorionic Diamniotic Twin Pregnancy. Clinical case
DOI:
https://doi.org/10.18041/2390-0512/biociencias.2.12677Keywords:
Monochorionic Biamniotic pregnancy, Twin-to-Twin Transfusion Syndrome, Intrauterine Growth RestrictionAbstract
Introduction: Monochorionic diamniotic pregnancies (MCBA) represent around 15% of twin pregnancies, with feto-fetal transfusion syndrome (TTTS) and intrauterine growth restriction (IUGR) being some of the most serious gestational complications. Early detection of these complications requires strict echographical– ultraosound monitoring. This article reports on the case of a pregnancy at 21 weeks of gestation in which MCBA and FTTS were detected, whose treatment was successful.
Case report: this is a pregnancy in a 29-year-old woman with a diagnosis of MCBA and STFF, which had IUGR grade IIA in one of the fetuses; Treatment was performed using laser photocoagulation to occlude the abnormal vascular anastomoses; The pregnancy continued until week 32, when a cesarean section was performed, with the delivery of two live neonates in good general condition, with no signs of fetal hypoxia.
Conclusion: Based on evidence, strict ecological monitoring in patients with monochorionic twin pregnancies as an early detection tool that allows the timely identification of these pregnancies that present
TTTS in early stages with association with selective IUGR and thus be able to make the right choice. of the treatment. fetal therapy vs. Expectation should always be individualized.
Downloads
References
1. Ferriman E, Stratton S, Stern V. Twin pregnancy. Obstetric Gynecology Reproduction Medical. [Internet]. 2018; 28(8): 221-8. Disponible en https://www.researchgate.net/publication/326760215_Twin_pregnancy.
2. Molina-Giraldo S, Hincapié-Porras C. Cirugía fetal láser en síndrome de transfusión feto-feto y restricción selectiva del crecimiento intrauterino. Revista Peruana de Ginecología y Obstetricia, 2018; 64(4): 587-597.
3. Townsend R, D’Antonio F, Sileo FG, Kumbay H, Thilaganathan B, Khalil A. Perinatal outcome of monochorionic twin pregnancies complicated by selective fetal growth restriction according to management: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019; 53 (1):36-46. https://doi.org/10.1002/uog.20114.
4. Molina-Giraldo S, Solano-Montero AF, Santana-Corredor NL, Ortega C, Alfonso-Ayala DA. Resultados perinatales en embarazos múltiples monocoriales relacionados con las características placentarias. Ginecol Obstet Mex. 2017;85(2):80-91.
5. Sociedad Española de Ginecología y Obstetricia. Gestación monocorial. Prog Obstet Ginecol 2020;63(2):123-145.
6. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol [Internet]. 1999;19(8 Pt 1):550–5. https://doi.org/10.1038/sj.jp.7200292.
7. Valsky DV, Eixarch E, Martínez JM, Crispi F, Gratacós E. Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas. Semin Fetal Neonatal Med. 2010 Dec;15(6):342-8. DOI: 10.1016/j.siny.2010.07.002.
8. Buca D, Pagani G, Rizzo G, Familiari A, Flacco ME, Manzoli L et al. Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2017;50(5):559-68. https://doi.org/10.1002/uog.17362.
9. Mackie FL, Morris RK, Kilby MD. Fetal Brain Injury in Survivors of Twin Pregnancies Complicated by Demise of One Twin: A Review. Twin Res Hum Genet. 2016;19(3):262–7. https://doi.org/10.1017/thg.2016.39.
10. Gapp-Born E, Sananes N, Weingertner A, Guerra F, Kohler M, Fritz G. Predictive value of cardiovascular parameters in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014; 44(4):427-433. https://doi.org/10.1002/uog.13351.
11. Pantoja M, Frías Z, Marchena A. Manejo del síndrome de transfusión feto fetal en gestaciones gemelares monocoriales. Revista Cubana de Obstetricia y Ginecología [Internet]. 2016 42 (4).
12. Hecher K, Gardiner HM, Diemert A, Bartmann P. Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome. Lancet Child Adolesc Heal [Internet]. 2018;2(7):525-35. https://doi.org/10.1016/s2352-4642(18)30127-5.
13. Ishii K, Wada S, Takano M, Nakata M, Murakoshi T, Sago H. Survival Rate without Brain Abnormalities on Postnatal Ultrasonography among Monochorionic Twins after Fetoscopic Laser Photocoagulation for Selective Intrauterine Growth Restriction with Concomitant
Oligohydramnios. Fetal Diagn Ther. 2018;1101. https://doi.org/10.1159/000486130.
14. Van Klink JMM, Koopman HM, Van Zwet EW, Oepkes D, Walther FJ, Lopriore E. Cerebral injury and neurodevelopmental impairment after amnioreduction versus laser surgery in twin-twin transfusion syndrome: A systematic review and meta-analysis. Fetal Diagn Ther. 2013;33(2):81-9. https://doi.org/10.1159/000341814.
15. Akkermans J, Peeters SHP, Klumper FJ, Lopriore E, Middeldorp JM, Oepkes D. Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review. Fetal Diagn Ther. 2015;38(4):241-53. https://doi.org/10.1159/000437053.
16. Sago H, Ishii K, Sugibayashi R, Ozawa K, Sumie M, Wada S. Fetoscopic laser photocoagulation for twin– twin transfusion syndrome. J Obstet Gynaecol Res. 2018;44(5):831–9. https://doi.org/10.1111%2Fjog.13600.
17. Emery SP, Hasley SK, Catov JM, Miller RS, Moon-Grady AJ, Baschat AA, et al. North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome. Am J Obstet Gynecol [Internet]. 2016;215(3):346.e1-346.e7. https://doi.org/10.1016/j. ajog.2016.04.024.
18. Molina-Giraldo S, Papanna R, Moise KJ, Johnson A. Management of stage I twin-to-twin transfusion syndrome: An international survey. Ultrasound Obstet Gynecol. 2010;36(1):42–7. https://doi.org/10.1002/uog.7566.
19. Goya M, Carreras E, Cabero L. Re: ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;48(5):669-70. https://doi.org/10.1002/uog.17218.
20. Royal College of Obstetricians and Gynaecologists. Management of Monochorionic Twin Pregnancy: Green-top Guideline No. 51. BJOG An Int J Obstet Gynaecol. 2017;124(1): e1-45
21. Robyr R, Yamamoto M, Ville Y. Selective feticide in complicated monochorionic twin pregnancies using ultrasound-guided bipolar cord coagulation. BJOG. 2005;112(10):1344-8. https://doi.org/10.1111/j.1471-0528.2005.00746.x.
22. Ville Y. Fetal therapy: practical ethical considerations. Prenat Diagn. 2011; 31 (7): 621-7. https://doi.org/10.1002/pd.2808.
23. Lewi L, Gratacos E, Ortibus E, Van Schoubroeck D, Carreras E, Higueras T, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. Am J Obstet Gynecol. 2006;194(3):782-9. https://doi.org/10.1016/j.ajog.2005.09.013.
24. Parra-Cordero M, Bennasar M, Martínez JM, Eixarch E, Torres X, Gratacós E. Cord occlusion in monochorionic twins with early selective intrauterine growth restriction and abnormal umbilical artery Doppler: A consecutive series of 90 cases. Fetal DiagnTher 2016;39(3):186-91. https://doi.org/10.1159/000439023.
25. Quintero RA, Bornick PW, Morales WJ, Allen MH. Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation. Am J Obstet Gynecol. 2001;185(3):689-96. https://doi.org/10.1067/mob.2001.116724.
26. Has R, Kalelioglu I, Corbacioglu Esmer A, Ermis H, Dural O, Dogan Y et al. Bipolar cord coagulation in the management of complicated monochorionic twin pregnancies. Fetal DiagnTher. 2014; 36 (3): 190-5. https://doi.org/10.1159/000360853.
27. Chalouhi GE, Marangoni MA, Quibel T, Deloison B, Benzina N, Essaoui M et al. Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionicdiamniotic twin pregnancies diagnosed in the second trimester of pregnancy. Prenat Diagn. 2013; 33 (2):109-15. https://doi.org/10.1002/pd.4031.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Biociencias
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
