title: Rapid onset of severe twin-twin transfusion syndrome caused by placental venous thrombosis.
abstract: We report a case of rapid onset of severe twin-twin transfusion syndrome (TTTS) at 25 weeks gestation in a monochorionic twin pregnancy that was uneventful before that time. Thrombosis of a main venous branch draining several arteriovenous (AV) anastomoses to the donor changed the previous hemodynamic balance that existed between multiple bidirectional AV anastomoses. The opposing AVs became hemodynamically uncompensated and, despite amnioreductions, severe TTTS developed. At 27 weeks a cesarean section was performed because of worsening cardiotocography parameters of both fetuses. Birth weights were 750 and 1840 g, and initial hemoglobin concentrations were 9.2 and 13.4 mmol/liter for donor and recipient, respectively. The recipient twin died 5 months later of an ischemic, necrotic, and perforated small intestine due to a thrombosed superior mesenteric artery. The donor is well at 2.5 years. No abnormalities in several factors associated with thrombophilia, including factor V Leiden mutations, were found in the parents.
authors: Department of Pathology, University Medical Center Utrecht, PO Box 85500, 3508 GA The Netherlands.
authors: Peter G J
authors: PG
authors: Nikkels
authors: Martin J C
authors: MJ
authors: van Gemert
authors: Krystyna M
authors: KM
authors: Sollie-Szarynska
authors: Harry
authors: H
authors: Molendijk
authors: Bert
authors: B
authors: Timmer
authors: Geoffrey A
authors: GA
authors: Machin
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D005330:Fetofetal Transfusion / Q000209:etiology / Q000473:pathology*; D006801:Humans; D010920:Placenta / Q000098:blood supply*; D010927:Placental Insufficiency / Q000209:etiology / Q000473:pathology*; D011247:Pregnancy; D014430:Twins, Monozygotic; D020246:Venous Thrombosis / Q000150:complications / Q000473:pathology*