Severe brain damage from twin-twin transfusion syndrome treated with serial amnioreductions after 26 weeks: a case to reconsider the gestational age limits of laser therapy.
We report a case of monochorionic twin pregnancy complicated by twin-twin transfusion syndrome (TTTS) diagnosed in the late second trimester and treated with two amnioreductions. Three days after the first amniodrainage, the recipient twin developed intracranial ventriculomegaly and, similarly, after a few days, the donor showed signs of brain damage at MRI. We discuss the possible mechanism of brain damage of amnioreductions performed after 26 weeks of gestation in a monochorionic pregnancy with TTTS as a result of a placental 'steal' phenomenon.
Department of Obstetrics and Gynecology, Materno-Fetal Unit, University of Brescia, Brescia, Italy. afichera@med.unibs.it
A
A
Fichera
C
C
Ambrosi
F
F
Taddei
R
R
Gasparotti
T
T
Frusca
D000328:Adult; D000653:Amniotic Fluid; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005333:Fetus / Q000098:blood supply; D005865:Gestational Age; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology*; D053685:Laser Therapy; D011247:Pregnancy; D016216:Ultrasonography, Prenatal