Feto-fetal Transfusion Syndrome Research Articles

Multicystic encephalomalacia following intrauterine single fetal death in second-trimester and subsequent fetofetal transfusion syndrome in monochorionic twin pregnancy: A case report

Multicystic encephalomalacia is a condition of cerebral necrosis followed by the formation of cystic lesions of varying sized starting from the periventricular area and may extending to the cerebral cortex. This disorder may happens in surviving cotwins after the second and third-trimester intrauterine fetal death of one twin in monochorionic pregnancies.

The role of infection factor in premature rupture of amniotic membranes after laser coagulation of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome

The role of infection factor in premature rupture of amniotic membranes after laser coagulation of placental anastomoses in monochorionic twins with feto-fetal transfusion syndrome

A mould in the fold should never grow old: cutaneous aspergillosis in a preterm neonate

A boy born at 25 weeks of gestation (birth weight 560 g) due to feto-fetal transfusion syndrome (mono-chorionic, di-amniotic gemini) was noticed on his ninth day of life to have multiple skin lesions on the abdomen, buttocks, and thighs (Figure 1A, B). The mother and his twin brother had no apparent skin abnormalities. Microbiological cultures from skin swabs and scrapings yielded growth of moulds, suggestive of Aspergillus species (Figure 1C-G). Matrix assisted laser desorption/ionization time-of-flight mass spectrometry confirmed Aspergillus fumigatus.

Perinatal outcomes in a combination of feto-fetal transfusion syndrome and selective fetal growth retardation syndrome in monochorionic twins

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ перинатальных исходов у близнецов из монохориальных диамниотических двоен, перенесших синдром фето-фетальной трансфузии и синдром селективной задержки роста плода в период внутриутробного развития. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проведено проспективное когортное исследование новорожденных из монохориальных диамниотических двоен. В 1-ю группу вошли 100 новорожденных из монохориальных диамниотических двоен после лазерной коагуляции плацентарных анастомозов с целью коррекции синдрома фето-фетальной трансфузии II—IV степени по Квинтеро без признаков синдрома селективной задержки роста плода: 50 доноров и 50 реципиентов. Во 2-ю группу вошли 90 новорожденных из монохориальных диамниотических двоен после лазерной коагуляции плацентарных анастомозов с целью коррекции синдрома фето-фетальной трансфузии II—IV степени по Квинтеро с наличием синдрома селективной задержки роста плода: 40 доноров и 50 реципиентов. Анализировали основные перинатальные показатели: гестационный возраст, оценку по шкале Апгар, антропометрические показатели при рождении, диссоциацию массы тела между близнецами при рождении, длительность респираторной поддержки, поражение центральной нервной системы, продолжительность пребывания в стационаре, постконцептуальный возраст при выписке из стационара, показатели перинатальной и неонатальной смерти. <h3>РЕЗУЛЬТАТЫ</h3> Новорожденные из монохориальных диамниотических двоен, развивавшиеся в условиях синдрома фето-фетальной трансфузии и синдрома селективной задержки роста плода, представляли группу более высокого перинатального риска развития осложненного течения неонатального периода по сравнению с таковым у монохориальных близнецов, перенесших синдром фето-фетальной трансфузии без синдрома селективной задержки роста плода. Новорожденные из 2-й группы имели достоверно (<i>p</i>=0,008) более низкий гестационный возраст — 29,2±2,6 нед по сравнению с таковым у пациентов 1-й группы. Выявлены значимые различия по физическому развитию монохориальных близнецов 2-й группы. У доноров (внутриутробный период которых протекал с синдромом селективной задержки роста) 2-й группы были значительно снижены все антропометрические показатели при рождении по сравнению с таковыми у реципиентов: масса тела (<i>p</i>&lt;0,001), длина (<i>p</i>&lt;0,001), окружность головки (<i>p</i>=0,04), окружность грудной клетки (<i>p</i>=0,002). Новорожденные 2-й группы имели более тяжелые проявления респираторного дистресс-синдрома по сравнению с пациентами 1-й группы: более длительный период протезирования дыхательной функции (у доноров <i>p</i>=0,002; у реципиентов <i>p</i>=0,02), достоверно чаще использовался инвазивный метод искусственной вентиляции легких (отношение шансов — ОШ 2,676; 95% доверительный интервал — ДИ 1,472—4,866). Тяжелые варианты гипоксического поражения центральной нервной системы (Р91 и Р52) значительно чаще диагностировались у пациентов 2-й группы за счет доноров с синдромом селективной задержки роста (ОШ 1,440; 95% ДИ 0,747—2,778). Новорожденные 2-й группы имели более продолжительный период выхаживания в условиях стационара (<i>p</i>=0,002) и высокий постконцептуальный возраст (<i>p</i>=0,005) при выписке. <h3>ЗАКЛЮЧЕНИЕ</h3> В<b></b> группе монохориальных диамниотических двоен, перенесших синдром фето-фетальной трансфузии и лазерную коагуляцию плацентарных анастомозов, наиболее значимую группу перинатального риска нарушений дыхательной и центральной нервной систем представляют плоды-доноры с признаками синдрома селективной задержки роста.

Experience with different techniques of laser coagulation of placental anastomoses to relieve feto-fetal transfusion syndrome in monochorionic diamniotic twins

Introduction. In recent years, the problem of multiple fetuses has become particularly important, which is associated with a steady increase in the frequency of multiple pregnancies worldwide. The feto-fetal transfusion syndrome (FFTS) is a classic example of unbalanced functioning of placental anastomoses, which leads to transfusion between fetuses. The incidence of this syndrome in a group of monochorionic diamniotic twins ranges from 8% to 15% and, in the absence of timely diagnosis and intrauterine correction, leads to death of one or both fetuses in 70-100% of cases. The effect of different methods of intrauterine surgical correction of FFTS in monochorionic diamniotic multiple fetuses on perinatal outcomes is of scientific interest. Purpose of the study — to investigate the effect of different types of laser coagulation of placental anastomosis (LCPA) on perinatal outcomes in intrauterine surgical correction of FFTS. Materials and methods. Depending on the surgical technique used, women were divided into three groups: the total placental anastomosis coagulation method, Group 1 (58 pregnant women); the selective placental anastomosis coagulation method, Group 2 (67 pregnant women); the sequential selective laser coagulation of placental anastomoses, Group 3 (62 pregnant women). Results. We analyzed the results of intrauterine surgical correction of FFTS by different methods of laser coagulation of placental anastomoses in 187 women with monochorionic diamniotic type of placentation of II-IV degrees according to Quintero. We obtained statistically significant differences in many perinatal period indices depending on the LCPA method used. Discussion. Sequential selective LCPA has proven to be the most effective, safe, and promising technique for correction of FFTS. The data obtained indicate possible ways to improve pregnancy prolongation and fetal survival rates after the use of intrauterine surgical correction of placental vascular anastomoses. Conclusion. Sequential selective LCPA has proven to be the best technique to correct FFTS with the least perinatal losses and postoperative complications, as well as the highest efficacy.

ОСОБЕННОСТИ ТЕЧЕНИЯ И СОСТОЯНИЯ ПЛОДОВ ПРИ МНОГОПЛОДНОЙ БЕРЕМЕННОСТИ, ОСЛОЖНЕННОЙ СИНДРОМОМ ФЕТО-ФЕТАЛЬНОЙ ТРАНСФУЗИИ

Problem of multiple pregnancy is one of the most relevant in obstetrics nowadays,being not only a medical, but also a socially significant problem. The problem of pregnancy management is of scientific and practical interest, it is caused by an increase in the number of multiple pregnancies. The current trend towards all cases of multiple pregnancies is explained by the activity of assisted reproductive technologies, the ever-increasing age of women in labor. This article discusses the features of the gestation period in multiple pregnancies, characteristic complications, as well as the features of the condition of the fetus and newborn in this condition. Multiple pregnancy is a model of fetoplacental insufficiency, which is explained by the fact that evolutionarily a woman's body is adapted to bear one fetus. According to research data, the course of multiple pregnancies is more often associated with the presence of various complications than the course of a singleton pregnancy. One of the most serious complications of multiple pregnancy is fetal-fetal transfusion syndrome. The occurrence of this complication requires the use of special tactics of pregnancy management, continuous monitoring of the condition of the mother and fetus, readiness to make emergency correct decisions about prolonging pregnancy or delivery, readiness to provide highly specialized assistance to the fetus and subsequent newborns. Clinical management of pregnancy, treatment and prognosis depend on the extent of development of feto-fetal transfusion syndrome, gestation, on which has developed the syndrome, presence or absence of the mother's genital or extragenital pathology, as well as the fetus. The main methods of treatment of feto-fetal transfusion syndrome are methods of fetal surgery, the most effective of which is the method of fetoscopic coagulation of placental anastomoses.

Clinical case of feto-fetal transfusion syndrome development in dichorionic twin pregnancies with fused placentas

This article analyzes a clinical case of feto-fetal transfusion syndrome development in dichorionic diamniotic twin pregnancies with fused placentas. Feto-fetal transfusion syndrome is a typical complication of the monochorionic type of placentation, but it is quite rare in the dichorionic type of placentation. In this case, the syndrome development became possible due to the close anatomical location of the placentas, which probably led to their fusion and the development of unbalanced interplacental anastomoses. During the observation of the patient in an antenatal clinic, no ultrasound signs of feto-fetal transfusion syndrome were detected. At a 25+5-week gestation period, the patient complained of cramping pains in the lower abdomen and liquid discharge from the genital tract. The patient was hospitalized at the second stage of labor and gave birth through the natural birth canal. The first fetus had polyhydramnios, the second one having extremely low water. The first was a premature boy in the occiput posterior position weighing 980 g and 32 cm in height in a state of severe asphyxia with an Apgar score of 1, 4 and 6 points. The second was a premature boy in breech position weighing 490 g and 32 cm in height, also in a state of severe asphyxia with an Apgar score of 1, 4 and 6 points. The first child developed severe multiple organ failure, which caused death on the twelfth day. The second newborn developed respiratory distress followed by death on the second day of the neonatal period.

Effect of monochorionicity on perinatal outcome and growth discordance in triplet pregnancy: collaborative multicenter study in England, 2000-2013.

To compare perinatal outcome and growth discordance between trichorionic triamniotic (TCTA) and dichorionic triamniotic (DCTA) or monochorionic triamniotic (MCTA) triplet pregnancies. This was a multicenter cohort study using population-based data on triplet pregnancies from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) maternity units and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort, for 2000-2013. Perinatal outcomes (from ≥ 24 weeks' gestation to 28 days of age), intertriplet fetal growth and birth-weight (BW) discordance and neonatal morbidity were analyzed in TCTA compared with DCTA/MCTA pregnancies. Monochorionic placentation of a pair or trio in triplet pregnancy (n = 72) was associated with a significantly increased risk of perinatal mortality (risk ratio, 2.7 (95%CI, 1.3-5.5)) compared with that in TCTA pregnancies (n = 68), due mainly to a much higher risk of stillbirth (risk ratio, 5.4 (95%CI, 1.6-18.2)), with 57% of all stillbirth cases resulting from fetofetal transfusion syndrome, while there was no significant difference in neonatal mortality (P = 0.60). The associations with perinatal mortality and stillbirth persisted when considering only pregnancies not affected by a major congenital anomaly. DCTA/MCTA triplets had lower BW and demonstrated greater BW discordance than did TCTA triplets (P = 0.049). Severe BW discordance of > 35% was 2.5-fold higher in DCTA/MCTA compared with TCTA pregnancies (26.1% vs 10.4%), but this difference did not reach statistical significance (P = 0.06), presumably due to low numbers. Triplets in both groups were delivered by Cesarean section in over 95% of cases, at a similar gestational age (median, 33 weeks' gestation). The rate of respiratory (P = 0.28) or infectious (P = 0.08) neonatal morbidity was similar between the groups. Despite close antenatal surveillance, monochorionic placentation of a pair or trio in triamniotic triplet pregnancy was associated with a significantly increased stillbirth risk, mainly due to fetofetal transfusion syndrome, and with greater size discordance. In liveborn triplets, there was no adverse effect of monochorionicity on neonatal outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Modern aspects of the diagnosis and correction of feto-fetal transfusion syndrome in multifetal monochorial pregnancy

Modern aspects of the diagnosis and correction of feto-fetal transfusion syndrome in multifetal monochorial pregnancy

Multicystic encephalomalacia and gastrointestinal injury following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy: a case report

BackgroundMonochorionic multifetal pregnancies are at increased risk of adverse perinatal outcome because of placental vascular anastomoses. We present a case of multicystic encephalomalacia and gastrointestinal injury in two surviving fetuses following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy.Case presentationA 31-year-old nulliparous woman had a spontaneous monochorionic triamniotic triplet pregnancy. Three live fetuses with single placenta were seen at 8-week ultrasound scan. One fetus demised at 11 weeks and 3 days of gestation. Dilated echogenic bowel and ascites were found in one surviving fetus at 23 weeks of gestation. At 28 weeks of gestation, the pregnancy was complicated by fetofetal transfusion syndrome in which discordant amniotic fluid volumes were found. Two days later, emergency Caesarean section was performed because of worsening of fetal Doppler and biophysical profile. One baby was found to have jejunal atresia requiring surgery at 4 days old. He had periventricular leukomalacia and intracranial haemorrhage, but subsequent normal neurological development. Another baby had gastric perforation requiring surgery at 2 days old. He was confirmed to have multicystic encephalomalacia by cranial ultrasound and magnetic resonance imaging. He suffered from developmental delay, epilepsy and cerebral palsy.ConclusionThis case alerts the obstetricians the possible hypoxic-ischemic injury to the survivors of monochorionic triplet pregnancy after the co-triplet death in the first trimester and fetofetal transfusion syndrome. Antenatal assessment and postnatal follow-up are important for these high-risk multiple pregnancies.

Cirugía fetal láser en síndrome de transfusión feto feto y restricción selectiva del crecimiento intrauterino

Introducción. El embarazo gemelar monocorial biamniótico (MCBA) corresponde aproximadamente al 15% de los embarazos gemelares y, de estos, se estima que 10 a 15% desarrollan complicaciones propias de este tipo de embarazos, como la restricción selectiva del crecimiento intrauterino (RCIUS) y el síndrome de transfusión feto (STFF). La cirugía fetal láser permite tratar la causa de estas alteraciones hemodinámicas propias de los embarazos MCBA a través de la coagulación de las anastomosis placentarias, y es considerada actualmente la terapia de elección en el STFF y aplicable en algunos casos de RCIUS. Objetivos. Resaltar los aspectos generales de la cirugía fetal láser y describir la evidencia actual de la eficacia y seguridad de su uso en el STFF y la RCIUS. Metodología. Se realizó una búsqueda de la literatura de artículos publicados en revistas indexadas en las siguientes bases de datos: PUBMED, MEDLINE, EMBASE, Cochrane Library. Se incluyeron revisiones de tema, investigaciones originales y revisiones sistemáticas de la literatura, publicadas en los últimos 5 años. Además, se incluyen artículos clásicos relevantes en la historia de la cirugía fetal. Resultados. Producto de la revisión no sistemática de la literatura, se incluyeron 43 para la construcción de la presente revisión. Conclusiones. La presente revisión evidencia que la cirugía láser fetal mejora el pronóstico de los fetos con STFF. El uso de dicha terapia para los casos de restricción de crecimiento intrauterino selectivo no ha mejorado la sobrevida.

Gene polymorphisms of angiogenesis and vascular tone in women with monochorionic multiple pregnancies complicated by feto-fetal transfusion syndrome

Gene polymorphisms of angiogenesis and vascular tone in women with monochorionic multiple pregnancies complicated by feto-fetal transfusion syndrome

EP20.06: Initial experience of a fetal medicine service in the accomplishment of fetoscopy for the treatment of feto‐fetal transfusion syndrome

Feto-fetal transfusion syndrome (FFST) is an exclusive complication of monochorionic twin pregnancies and occurs in about 15% of these cases due to unbalanced blood exchange between fetal circulations through placental anastomoses. Diagnosis is made by ultrasonography, based on the binomial oligo-polydramnium, and the disease is classified in stages (Quintero standardisation). It presents high perinatal morbidity and mortality. Treatment chosen was fetoscopy by laser photocoagulation of the vascular anastomoses of the chorionic plaque. The aim of this study is to present the initial experience of Federal University of São Paulo fetal medicine service in this type of procedure. A prospective observational study was carried out. 16 and 26-week-old monochronic diamniotic pregnancies diagnosed with FFST stages II, III, IV or V of Quintero were included. These patients were submitted to fetoscopy for laser photocoagulation of the vascular anastomoses of placental chorionic plaque (SOLOMON technique). The study was approved by the ethics committee and patients selected signed a consent form. Twenty four pregnant women with FFST underwent fetoscopy between November 2012 and October 2016. Gestational age of the procedure ranged from 16 to 26 weeks (average 20.75 weeks). Time of procedure ranged from 30 minutes to 98 minutes (average 51.9 minutes). Age of delivery ranged from 22 to 37 weeks (average 30.54 weeks). In 6 cases (25%), septostomy occurred iatrogenically. In 4 cases (16.7%) bleeding occurred during the laser. In 21 cases (87.5%) there was at least one live fetus until delivery; And in 45.8% (11) of the pregnancies there were two fetuses alive until delivery. In 4 cases (16.7%) there was FFST recurrence and in 1 case (4.2%) we observed development of the anemia-polycythemia sequence. Development of new centres specialised in fetoscopy is very important. Our results approximate the data described in the literature.

Perinatal outcomes after different intrauterine surgical correction techniques for feto-fetal transfusion syndrome in monochorionic diamniotic twin pregnancy

Perinatal outcomes after different intrauterine surgical correction techniques for feto-fetal transfusion syndrome in monochorionic diamniotic twin pregnancy

Fetal Neurosonogaphy: Ultrasound and Magnetic Resonance Imaging in Competition.

Fetal Neurosonogaphy: Ultrasound and Magnetic Resonance Imaging in Competition.

Síndrome de transfusión feto fetal: Una mirada global a la enfermedad

Introducción: El síndrome de transfusión feto- feto es una enfermedad compleja producida aproximadamente en 15% de los embarazos monocoriales; a pesar de su baja incidencia, su importancia radica en las graves complicaciones perinatales. Su fisiopatología está basada en el proceso por el cual los gemelos comparten las dos circulaciones a través de vasos sanguíneos anómalos, con posterior alteración hemodinámica del gemelo receptor y donante. El diagnóstico es primordialmente ecográfico y su tratamiento definitivo actual, consiste en estrategias in útero realizadas con el fin de ubicar y sellar los vasos, proporcionando una circulación individual, buscando contrarrestar su mal pronóstico, que puede llegar a una mortalidad de hasta un 100% en aquellos sin tratamiento. Objetivo: Realizar una revisión de la literatura sobre el síndrome de transfusión feto - feto abarcando una actualización en los diferentes componentes que incluyen: epidemiología, fisiopatología, avances en Diagnóstico clínico y tratamiento. Metodología: Se hizo una búsqueda en bases de datos como PubMed, Cochrane, Sciencedirect y Google académico; se encontraron 78 artículos, de los cuales finalmente cumplieron con los criterios de actualización, pertinencia y calidad 32 artículos; se revisó fisiopatología, diagnóstico y tratamiento. Se descartaron artículos que no cumplían con criterios de inclusión. Resultados: Se seleccionó la información más actualizada y completa de las bases de datos encontradas, respecto a clasificación, etiología, fisiopatología, diagnóstico, tratamiento y pronóstico. Conclusiones: El síndrome de Transfusión Feto-Feto consiste en un desbalance hemodinámico de anastomosis placentarias, niveles aumentados de vasopresina y finalmente cambios en el eje renina angiotensina aldosterona, que requiere un diagnóstico temprano con tratamiento oportuno para mejorar el pronóstico y prevenir complicaciones fetales. [Durán-Morales MA, Ariza-Parra EJ. Síndrome de transfusión feto fetal: Una mirada global a la enfermedad. MedUNAB 2016; 18(3): 204-212].

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Objective: To report the outcome of monochorionic (MC) and dichorionic (DC) triamniotic (TA) triplet pregnancies treated with endoscopic laser coagulation of the communicating placental vessels for severe feto-fetal transfusion syndrome (FFTS) and selective fetal growth restriction (sFGR). Methods: Laser surgery was performed at 18 (15-24) weeks' gestation in 11 MCTA and 33 DCTA pregnancies complicated by FFTS and 14 DCTA pregnancies complicated by sFGR. Data from our study and previous reports were pooled using meta-analytic techniques. Results: Survival of at least one baby and survival among all fetuses was 97.0 and 72.7% in DCTA pregnancies with FFTS, 78.6 and 52.4% in DCTA pregnancies with sFGR and 81.8 and 39.4% in MCTA pregnancies with FFTS. In the combined data from our study and previous reports, the pooled survival rates in 132 DCTA pregnancies with FFTS were 94.4 and 76.1%, and in 29 MCTA pregnancies with FFTS, they were 80.6 and 57.5%. Conclusions: Survival after laser surgery is higher in DC triplets with FFTS than in those with sFGR and in DC than in MC triplets with FFTS.

Incidences of Feto-Fetal Transfusion Syndrome and Perinatal Outcomes in Triplet Gestations with Monochorionic Placentation

Introduction: This study aimed to determine the incidences of feto-fetal transfusion syndrome (FFTS) and perinatal outcomes in triplet gestations with monochorionic placentation. Materials and Methods: In this retrospective cohort study, we evaluated the incidences of FFTS and perinatal outcomes at 28 days of age in cases of triplet gestations with monochorionic placentation who visited our centers before 16 weeks of gestation and delivered over a period of 11 years. Results: In 41 triplet gestations (17 monochorionic triamniotic, 22 dichorionic triamniotic, 1 dichorionic diamniotic, and 1 monochorionic monoamniotic), the incidence of FFTS was 17.1%, and the median gestational age at FFTS diagnosis was 19 weeks. In 123 triplets, the incidences of fetal death and neonatal death at 28 days of age were 8.1 and 0.9%, respectively. None of the surviving infants had grade 3 or 4 intraventricular hemorrhage, while cystic periventricular leukomalacia occurred in 6 of 113 infants (5.3%). The incidence of poor outcomes (death or any major neurological complication at 28 days of age) was 13.8%. Discussion: Seventeen percent of triplet pregnancies with monochorionic placentation developed FFTS, and 14% had a poor outcome. Therefore, triplet gestations with monochorionic placentation should be followed carefully.

Методика Соломона при оперативном лечении синдрома фето-фетальной трансфузии

Методика Соломона при оперативном лечении синдрома фето-фетальной трансфузии

P15.02: Incidences of fetofetal transfusion syndrome and perinatal outcomes in triplet gestations with monochorionic placentation

P15.02: Incidences of fetofetal transfusion syndrome and perinatal outcomes in triplet gestations with monochorionic placentation