Midtrimester genetic amniocentesis of a twin gestation complicated by immediate severe fetal bradycardia with subsequent associated fetal anomalies.
We present an unusual complication of midtrimester genetic amniocentesis of a monochorionic twin gestation in which prolonged fetal bradycardia of 60 to 80 beats per minute sustained over two hours was associated with multiple subsequent fetal anomalies. These included: microcephaly, bilateral closed-lip schizencephaly, duodenal atresia, and complete paresis of the left upper extremity. Etiology of the fetal bradycardia was unclear. Fetal hemorrhage was not visualized despite targeted, continued real-time ultrasonography and was therefore considered an unlikely etiology. Although the bradycardia and associated hypoperfusion could alone explain the fetal outcome, destabilization of hemodynamics of a communicating vessel, resulting in a possible (although unproven) acute twin-twin transfusion induced at the time of amniocentesis due to decreased intra-amniotic pressure in association with a velamentous umbilical cord insertion could have led to this unusual occurrence.
Sherer
D M
DM
Department of Obstetrics and Gynecology, NICHD, Georgetown University Medical Center, Washington, DC, USA.
Salafia
C M
CM
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects*; D001919:Bradycardia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000209:etiology*; D006340:Heart Rate, Fetal; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011272:Pregnancy, Multiple; D014430:Twins, Monozygotic