Angiogenic factor abnormalities and fetal demise in a twin pregnancy.
BACKGROUND
An otherwise healthy 31-year-old gravida 2 para 1 woman with a spontaneous dichorionic, diamniotic twin pregnancy presented with hypertension, nephrotic syndrome and renal insufficiency at 19 weeks' gestation. Fetal ultrasound revealed severe intrauterine growth restriction of one fetus and measurement of serum anti-angiogenic and angiogenic factors were consistent with a profound anti-angiogenic state. After one fetus died and the placenta became increasingly echogenic, the patient improved clinically, and weekly ultrasound assessments of the intact co-twin from 22 weeks onwards demonstrated symmetrical fetal growth along the 10th centile. Repeat serum angiogenic factors at 24 weeks' gestation revealed considerable improvement of the anti-angiogenic state and paralleled resolution of the clinical syndrome.


METHODS
Physical examination, laboratory evaluations including full blood count, liver function tests, electrolytes, renal function tests, screening for glomerular-based disease, 24-h urine collection for total protein, analysis of serum anti-angiogenic and angiogenic factors, fetal ultrasonography and placental Doppler examination.


METHODS
Spontaneous resolution of early-onset pre-eclampsia after single fetal demise in a twin pregnancy.


RESULTS
Labetalol was given to treat hypertension and furosemide was given as needed for edema. The patient was closely followed up throughout pregnancy in a combined nephrology/obstetrics outpatient clinic.
Division of Nephrology, Department of Medicine, Mount Sinai Hospital and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Michelle A
MA
Hladunewich
Guy
G
Steinberg
S Ananth
SA
Karumanchi
Richard J
RJ
Levine
Sarah
S
Keating
John
J
Kingdom
Johannes
J
Keunen
D042501:Angiogenic Proteins / Q000378:metabolism*; D005260:Female; D005313:Fetal Death / Q000000981:diagnostic imaging / Q000378:metabolism*; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000378:metabolism*; D006801:Humans; D009404:Nephrotic Syndrome / Q000378:metabolism*; D011225:Pre-Eclampsia / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome; D014427:Twins; D016216:Ultrasonography, Prenatal
D042501:Angiogenic Proteins