title: Diffuse brain damage caused by acute twin-twin transfusion during late pregnancy.
abstract: BACKGROUND
  Monoamniotic twinning is a relatively rare event with increased antenatal and perinatal mortality. We describe a brain damage detected in a surviving monoamniotic twin after intrauterine death of the co-twin at 37 weeks of gestation.
  
  
  RESULTS
  Severe entanglement and knotting of the umbilical cords was apparent at the time of delivery and a portion of the cord to the dead twin was narrowed significantly. It was suggested that transfer of blood occurred across placental anastomoses from the survivor to the dead fetus, resulting in transient but severe hypovolemia in the survivor. It is difficult to prevent this type of brain damage because the course of acute twin-twin transfusion is very rapid and the damage has already occurred by the time the death of the twin is diagnosed.
  
  
  CONCLUSIONS
  We suggest that elective delivery should be considered in cases of monoamniotic twin pregnancies with additional risk factors.
authors.affiliation: Department of Pediatrics, School of Medicine, Faculty of Medicine, Kanazawa University, Japan. pedialib@med.kanazawa-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Wada
authors.forename: K
authors.initials: K
authors.lastname: Nunogami
authors.forename: T
authors.initials: T
authors.lastname: Wada
authors.forename: Y
authors.initials: Y
authors.lastname: Niida
authors.forename: A
authors.initials: A
authors.lastname: Yachie
authors.forename: S
authors.initials: S
authors.lastname: Koizumi
mesh_terms: D000328:Adult; D001925:Brain Damage, Chronic / Q000196:embryology*; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion; D006801:Humans; D011247:Pregnancy; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal