Selective feticide by embolization in twin-twin transfusion syndrome. A report of two cases.
BACKGROUND
The early development of complications in twin-twin transfusion syndrome is a poor prognostic sign. For this reason, new techniques for intrauterine therapy are being developed: invasive options, such as selective feticide of one of the twins, have been reported.


METHODS
Two cases of twin-twin transfusion syndrome in the late second trimester were treated by selective feticide using vascular embolization to the more severely damaged fetus. In one case the embolized fetus was a hydropic recipient with a normal cotwin; in the other, the donor fetus was affected by bilateral hydrocephalus. These fetuses underwent ultrasound-guided embolization using a bolus of histoacryl injected into the umbilical vein and fetal heart. Both patients went on to deliver healthy singletons in the third trimester.


CONCLUSIONS
In twin-twin transfusion syndrome of early onset, embolization may help one of the twins survive. This technique is neither time-consuming nor expensive and does not require a general anesthetic.
Donner
C
C
Department of Obstetrics and Gynecology, Pathology and Pediatrics, Erasme Hospital, Free University of Brussels, Belgium.
Shahabi
S
S
Thomas
D
D
Noël
J C
JC
Kirkpatrick
C
C
Rysselberghe
M V
MV
Hubinon
C
C
Vermeylen
D
D
Masters
L
L
Rodesch
F
F
D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005330:Fetofetal Transfusion / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011262:Pregnancy Trimester, Second; D014427:Twins