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Diffuse brain damage caused by acute twin-twin transfusion during late pregnancy
1Department of Pediatrics, School of Medicine, Faculty of Medicine, Kanazawa University, Japan. pedialib@med.kanazawa-u.ac.jp
Acta Paediatrica Japonica : Overseas Edition
|September 24, 1998
Summary
Monoamniotic twins face risks, including brain damage in survivors after a co-twin
Area of Science:
- Perinatology
- Neonatology
- Obstetrics
Background:
- Monoamniotic twinning presents significant antenatal and perinatal mortality risks.
- This case highlights brain damage in a surviving twin following intrauterine fetal demise of the co-twin at 37 weeks gestation.
Observation:
- Umbilical cords showed severe entanglement and knotting at delivery.
- A significant narrowing of the cord to the deceased twin was observed, suggesting potential blood transfer.
Findings:
- A proposed mechanism involves acute twin-twin transfusion across placental anastomoses, leading to severe hypovolemia in the survivor.
- The rapid progression of twin-twin transfusion makes prevention challenging, as damage may occur before diagnosis.
Implications:
- Consideration of elective delivery in monoamniotic twin pregnancies with added risk factors is suggested.
- This case underscores the critical need for vigilant monitoring and timely intervention in high-risk twin gestations.