Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailab...Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS.We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS.Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses,including arterio-arterial anastomosis and arterio-venous anastomosis.These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow.When encountering such challenging conditions,medical practitioners should discreetly compare the fetuses’characteristics with features of placental blood vessels and consult morphological and pathological findings.Furthermore,they should perform ultrasound examinations,particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS,especially in MC multiple pregnancies with abdominal symptoms.展开更多
One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental an...One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.展开更多
基金supported by the National Natural Science Foundation of China[grant number 81373249],[grant num-ber 81571855]Mittal Student Innovation Test Plan of Cen-tral South University[grant number MX2016447]Student Innovation Test Plan of Central South University[grant number CX2016343],[grant number YC2016714].
文摘Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS.We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS.Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses,including arterio-arterial anastomosis and arterio-venous anastomosis.These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow.When encountering such challenging conditions,medical practitioners should discreetly compare the fetuses’characteristics with features of placental blood vessels and consult morphological and pathological findings.Furthermore,they should perform ultrasound examinations,particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS,especially in MC multiple pregnancies with abdominal symptoms.
文摘One in three monochorionic twins may develop complications during pregnancy. Monochorionic twins, especially monochorionic diamniotic (MCDA), present specific problems caused by the presence of interfetal placental anastomoses. The first critical step in the management of MCDA twins is identification in the first trimester. Secondly, close follow-up every 2 weeks is mandatory to allow early diagnosis and timely treatment of twin-twin transfusion syndrome. Other potentially severe complications include selective fetal growth restriction, twin anemia polycythemia syndrome or single fetal death. Thirdly, a correct differential diagnosis is critical to establish the best therapy. This may represent a clinical challenge since MCDA twin complications often overlap. A simple diagnostic algorithm may be of great help to establish the right diagnosis and management option. In this review we summarize the main steps for the clinical follow-up, differential diagnosis, and targeted management of MCDA twins complications.
