title: Prenatal spontaneous disruption of the dividing membrane in monochorionic diamniotic twins detected at the time of fetoscopic laser photocoagulation.
abstract: Spontaneous antepartum rupture of the dividing membrane occurring in monochorionic diamniotic twins (MD twin) is an extremely rare complication and difficult to diagnose prenatally. We present a case of pseudo-monoamniotic twins derived from an MD twin gestation, which was suspected by ultrasound and was confirmed by antepartum fetoscopy. A 28-year-old woman, gravida 1, para 1 at 24 weeks of gestation was referred because of suspected polyhydroamnios in an MD twin. Ultrasound suggested twin-twin transfusion syndrome stage III, spontaneous rupture of the dividing membranes and cord entanglement. Fetoscopic laser photocoagulation (FLP) was performed using the Nd:YAG laser on 12 placental vascular connections. Fetoscopy revealed the spontaneous rupture of the dividing membrane and cord entanglement. The remainder of the pregnancy was managed as a monoamniotic twin gestation. Elective cesarean section was performed at 32 weeks of gestation following antenatal steroids and concordantly grown healthy male infants were delivered.
authors.affiliation: Department of Obstetrics and Gynecology, University of Occupational and Environmental Health, Kitakyushu, Japan. yoppy@med.uoeh-u.ac.jp
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Yukiyo
authors.initials: Y
authors.lastname: Aiko
authors.forename: Hirohide
authors.initials: H
authors.lastname: Inagaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.forename: Toru
authors.initials: T
authors.lastname: Hachisuga
mesh_terms: D000328:Adult; D005260:Female; D005330:Fetofetal Transfusion / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005332:Fetoscopy / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011272:Pregnancy, Multiple; D014430:Twins, Monozygotic; D014463:Ultrasonography