Quantification of Feto-fetal Transfusion Rate through a Single Placental Arterio-venous Anastomosis in a Monochorionic Twin Pregnancy

Abstract Twin-to-twin transfusion syndrome (TTTS) is due to unbalanced inter-twin blood flow through placental vascular anastomoses. We present a TTTS-case treated with fetoscopic laser surgery that allowed us to calculate the net inter-twin blood flow. In the weeks following laser treatment, the ex...

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Bibliographic Details
Published in:Placenta (Eastbourne) 2009-03, Vol.30 (3), p.223-225
Main Authors: Lopriore, E, Van den Wijngaard, J.P.H.M, Pasman, S.A, Oepkes, D, Walther, F.J, Van Gemert, M.J.C, Vandenbussche, F.P.H.A
Format: Article
Language:English
Subjects:
Arteriovenous Anastomosis - pathology
Arteriovenous Anastomosis - physiopathology
Biological and medical sciences
Blood Flow Velocity
Blood Transfusion, Intrauterine
Embryology: invertebrates and vertebrates. Teratology
Female
Fetofetal Transfusion - pathology
Fetofetal Transfusion - physiopathology
Fetofetal Transfusion - therapy
Fundamental and applied biological sciences. Psychology
Humans
Inter-twin blood flow
Internal Medicine
Laser Therapy
Obstetrics and Gynecology
Placenta - pathology
Placenta - physiopathology
Placental vascular anastomoses
Pregnancy
Twin-to-twin transfusion syndrome
Twins, Monozygotic - physiology
Young Adult
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Summary:Abstract Twin-to-twin transfusion syndrome (TTTS) is due to unbalanced inter-twin blood flow through placental vascular anastomoses. We present a TTTS-case treated with fetoscopic laser surgery that allowed us to calculate the net inter-twin blood flow. In the weeks following laser treatment, the ex-recipient developed severe fetal anemia and was treated with two intrauterine adult red cell transfusions (at 26 and 29 weeks' gestation, respectively). After birth, placental injection with color-latex identified a single residual arterio-venous anastomosis from the ex-recipient to the ex-donor. We measured the fetal and adult hemoglobin concentrations in the anemic fetus before and after both intrauterine transfusions, and in both twins at birth. On the basis of these measurements, we calculated the blood flow across the residual arterio-venous anastomosis and found it to be 5.8 ± 1.5 mL/24 h after the 1st transfusion and 11.4 ± 2.9 mL/24 h after the 2nd transfusion.
ISSN:0143-4004
1532-3102
DOI:10.1016/j.placenta.2008.11.012