title: An experience of laser surgery for feto-fetal transfusion syndrome complicated with unexpected feto-fetal hemorrhage in a case of monochorionic triamniotic triplets.
abstract: Feto-fetal transfusion syndrome (FFTS) in monochorionic triplets is a rare clinical entity which may share the principal adverse perinatal outcomes of twin-twin transfusion syndrome. Recently, favorable prognoses regarding morbidity and mortality in twins after selective laser photocoagulation of placental communicating vessels (SLPCV) have been described. But descriptions of this procedure in monochorionic triplet cases are limited. This is the case report of an experience of SLPCV applied to monochorionic triamniotic triplets with FFTS. Triplet A had polyhydramnios, while absent end-diastolic flow in the umbilical artery of triplet B, the triplet with anhydramnios, was persistent. Triplet C looked normal, vertical amniotic pocket and Doppler studies yielding normal results. At the beginning of the SLPCV procedure, feto-fetal hemorrhage, subsequent to the fetal death of the donor triplet, occurred. Both surviving cofetuses showed persistent bradycardia; and 1 fetus died while the other recovered from the fetal bradycardia. All vascular anastomoses between the 3 triplets could be identified and obliterated, requiring two trocars. Our fetoscopic observation revealed feto-fetal hemorrhage after demise of monochorionic triplet, which led to injury of other fetuses due to hypovolemia in an instant. In conclusion, SLPCV might be a valid option for FFTS in triplet cases, while further experience is required in order to evaluate the risks and benefits of this procedure in triplet cases.
authors.affiliation: Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, and Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan. keisui28@med.niigata-u.ac.jp
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Numata
authors.forename: Akira
authors.initials: A
authors.lastname: Kikuchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Takakuwa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D010920:Placenta / Q000098:blood supply; D011247:Pregnancy; D014310:Triplets