Results of efferent therapy in monochorionic diamniotic twins with dissociation of fetal development (three clinical observations)

Abstract

The article presents three clinical observations of successful conservative treatment of pregnant women with monochorionic, diamniotic twins (MDT), coming naturally. In all cases, there were manifestations of twin-to-twin transfusion syndrome (TTTS) with progressive blood flow disorders in the utero-placental space with a pronounced delay in the development of one of the fetuses. In the early stages of pregnancy was supposed to terminate the pregnancy, but the women refused. Pregnant women were admitted to the perinatal center at 23, 23 and 24-25 weeks, respectively. During the examination, the diagnosis was confirmed, at the same time in all cases, the patients found manifestations of endotoxicosis and inflammatory response. Pregnant conducted methods of detoxicational (efferent) therapy in the form of photomodification of blood with sessions of laser and ultraviolet radiation in combination: in the first case — plasmaexchange with 5% albumin solution No 6 and the cascading plasmafiltration No 5; in the second observation - with medium volume plasmapheresis No 7, hemosorption No 1; in the 3rd observation – with plasmapheresis No 7, hemosorption No 3. Complications at efferent therapy was not, indices of homeostasis of pregnant women in the dynamics normalized. Blood flow disorders in the placenta persisted, but there was a steady increase in body weight of the fetus. In general, women’s pregnancies were prolonged for 11, 13 and 9 weeks, respectively (in the first two cases, women were even temporarily discharged home). Childbirths in all cases were performed by operational pathway, there were no complications in childbirth and after childbirth in mothers. All six children were born alive with mild and moderate prematurity and did not need long-term intensive care. All were on breast-feeding, in dynamics surveillance caught up with contemporaries in development.