title: Umbilical artery steal syndrome and distal gangrene in a case of twin-twin transfusion syndrome.
abstract: BACKGROUND
  Vascular accidents in the survivor from pregnancies with twin-twin transfusion syndrome have been attributed to the release of thromboplastin from the dead fetus.
  
  
  METHODS
  In a woman presenting at 22 weeks' gestation with acute polyhydramnios due to twin-twin transfusion syndrome, endoscopic laser coagulation of the communicating vessels was performed. At endoscopy, the toes of the left foot of the recipient fetus were noted to be gangrenous. This fetus had only a left umbilical artery, which was markedly dilated, and Doppler studies demonstrated impaired perfusion of the left leg. In four control fetuses with a single umbilical artery, Doppler studies demonstrated normal waveforms in both legs.
  
  
  CONCLUSIONS
  In twin-twin transfusion syndrome, fetal peripheral gangrene may occur before the death of one twin. The ischemic necrosis of the toes probably resulted from the combined effect of polycythemia and umbilical artery steal syndrome. Interruption of twin-twin transfusion syndrome caused resolution of the polycythemia and prevented further damage by removing one of the components of the peripheral ischemia.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College School of Medicine, Denmark Hill, London, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Hecher
authors.forename: Y
authors.initials: Y
authors.lastname: Ville
authors.forename: K
authors.initials: K
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D005330:Fetofetal Transfusion / Q000150:complications*; D005734:Gangrene; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D011247:Pregnancy; D012039:Regional Blood Flow; D014034:Toes / Q000098:blood supply / Q000473:pathology*; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology*