Twin-to-twin transfusion syndrome: selective feticide by embolization of the hydropic fetus.
To improve the outcome of severe twin-to-twin transfusion syndrome with 1 hydropic fetus and to prevent ischemic sequelae in the survivor, we developed a technique of selective feticide by vascular embolization of the most severely damaged twin. Acute second trimester polyhydramnios occurred in 4 biamniotic monochorial twin pregnancies, with 1 fetus normal on ultrasound but the other severely damaged by hydrops and hypertrophic hypokinetic cardiomyopathy. The hydropic fetus underwent embolization using a bolus of histoacryl injected into the umbilical vein and fetal heart under ultrasound guidance. In 1 triplet pregnancy with a set of monochorial fetuses, premature labor occurred at 26 weeks, 2 weeks after embolization, and there were 2 neonatal deaths. The 3 other cases resulted in the birth of a normal infant at 31-37 weeks of gestation. This suggests that in twin-to-twin transfusion syndrome with severe polyhydramnios and hydrops of 1 fetus, embolization may salvage the other twin.
Dommergues
M
M
Maternité Port-Royal-Baudelocque, Paris, France.
Mandelbrot
L
L
Delezoide
A L
AL
Aubry
M C
MC
Fermont
L
L
Caputo-Mahieu
D
D
Dumez
Y
Y
D004621:Embolization, Therapeutic; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000628:therapy*; D007231:Infant, Newborn; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D014430:Twins, Monozygotic