title: Prenatally Acquired Multiple Limb Ischemia in a Very Low Birth Weight Monochorionic Twin.
abstract: Limb ischemia is an extremely rare event occuring in monochorionic twin pregnancy complicated by twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). The authors describe a case of TTTS and TAPS treated successfully using amnioreduction and laser ablation. However, severe ischemia of both lower extremities in the recipient twin developed after the fetal treatment. This serious complication was diagnosed on MRI in utero and confirmed postnatally. Elective amputation of the affected limbs was performed. The etiology of the disease remains unclear despite profound clinical and histopathological examinations; although the role of thromboembolism in monochorionic pregnancy seems to be most likely, this unique case of multiple limb ischemia with distinct macroscopic findings has not yet been described.
authors.affiliation: Fetal Medicine Centre, Institute for the Care of Mother and Child, Prague, Czech Republic.
authors.forename: Zbyněk
authors.initials: Z
authors.lastname: Straňák
authors.forename: Peter
authors.initials: P
authors.lastname: Korček
authors.forename: Lucie
authors.initials: L
authors.lastname: Hympánová
authors.forename: Martin
authors.initials: M
authors.lastname: Kynčl
authors.forename: Ladislav
authors.initials: L
authors.lastname: Krofta
mesh_terms: D000671:Amputation, Surgical / Q000379:methods; D000740:Anemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D019102:Infant, Very Low Birth Weight; D007511:Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D038061:Lower Extremity Deformities, Congenital / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D011086:Polycythemia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D011247:Pregnancy; D014430:Twins, Monozygotic
keywords: Monochorionic pregnancy; Multiple limb ischemia; Twin-to-twin transfusion syndrome