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Nonimmune Hydrops Fetalis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Chelsea DeBolt, Katherine Connolly, Mary E. Norton, Joanne Stone
This complication of monochorionic twins leads to an imbalance in blood flow between the two fetuses, as the placenta acts as a site of arteriovenous communication between the two fetal circulations. The pathophysiology is not clearly understood, though it appears to be linked to disturbances in volume with a subsequent increase in central venous pressure [7]. This leads to hypoxia in the donor twin and vascular overload in the recipient twin. In some cases of twin-to-twin transfusion syndrome (TTTS) and TRAP sequence, invasive therapy with fetoscopy and laser coagulation or umbilical cord ligation have been associated in some studies with improved fetal survival (see Chapter 46).
Amniocentesis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Aris Antsaklis, Marianna Theodora
Amniocentesis is used for uterine decompression in case of hydramnios and twin-to-twin transfusion syndrome in monochorionic (MC) twins. Amnioinfusion has been used in cases of severe oligohydramnios, but research is needed in order to define both the indications and the outcome of such an intervention. Finally, thyroxin has been injected into the amniotic sac to treat goitrous hypothyroidism of the fetus.
Fetal surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Emily A. Partridge, Alan W. Flake
There have been two recent randomized controlled multicenter clinical trials supporting fetal intervention. The MOMS trial demonstrated improvement in neurologic morbidity of MMC with prenatal closure, and the European trial demonstrated efficacy of fetoscopic laser separation versus amnioreduction in twin-to-twin transfusion syndrome (TTTS). Further randomized trials are clearly needed prior to broad application of controversial procedures, such as fetoscopic balloon tracheal occlusion for CDH, however they would be impractical and potentially unethical in rare anomalies requiring fetal intervention such as congenital cystic adenomatoid malformation (CCAM), and sacrococcygeal teratoma (SCT), and in circumstances of clear rationale and demonstrated efficacy such as the EXIT procedure for obstructive airway lesions.
The effects of intrauterine growth on physical and intellectual development of one-year-old infants: a study on monochorionic twins with selective intrauterine growth restriction
Published in Journal of Obstetrics and Gynaecology, 2023
Xianping Huang, Huiqiu Xiang, Jiale Bao, Jing Zhu, Jiajia Chen, Panpan Zhou, Tong Zhou, Zhangye Xu
However, these studies did not rule out the effects of twin-to-twin transfusion syndrome (TTTS), causing a very poor prognosis in newborns. In the present study, monozygotic twins with sIUGR were enrolled to reduce the effects of confounding factors. The results showed that the PDI and MDI at 1 year old in the L-twin group were significantly lower than those in the H-twin group. The results of the stepwise regression analysis revealed that weight has a significant effect on both PDI and MDI. Our results are similar to those reported by Swamy et al. who demonstrated that the FGR resulted in lower neurocognitive scores in early childhood, and there were significant differences in size (Swamy et al. 2018). Several studies have shown a strong association of low birth weight with adults’ growth and health (Barker and Hanson 2004). Furthermore, our results suggested that suboptimal intrauterine growth was related to impaired cognitive outcomes, and the reduced birth weight could be a risk factor for cognitive outcomes. Obstetricians are asked to pay close attention to the long-term cognitive effects of FGR and low birth weight infants.
Prenatal Sonographic Detection of Monochorionic Twins with Bipartite Placenta
Published in Fetal and Pediatric Pathology, 2021
Mehmet Serdar Kutuk, Taha Takmaz, Arslan Bayram, Sule Ozturk
“Hybrid” combinations of sonographic findings in same-sex twins can occur, confounding the prenatal evaluation of multifetal pregnancies. Conventionally, the presence of two separate placentas is regarded as a reliable marker of dichorionicity. However, recent studies showed that the frequency of bipartite monochorionic twins is not as unusual as previously thought. Machin et al. reported a 1.3% rate of bipartite monochorionic twin pregnancies in their large postnatal series [6]. Moreover, Lopriore et al. demonstrated three cases involving bipartite monochorionic placentas, two of which had vascular anastomosis and developed twin-to-twin transfusion syndrome [7]. In the present case, the sonographically separate location of the placentas and the discontinuity between them falsely suggested dichorionic placentation with an obliterated lambda sign.
A Qualitative Framework of Cumulative Risk and Protection for Understanding Neurodevelopment and Clinical Progress: A Multiple Case Study Approach
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2021
Bianca C. Bondi, Debra J. Pepler, Mary Motz, Naomi C.Z. Andrews
Mother B had a long history of substance use, which resulted in her oldest child (not followed at BTC) from a previous relationship being apprehended early in life. Mother B also had a history of sexual, physical, and emotional abuse across development. Mother B had an eating disorder history and a family history of mental illness. Mother B was in a substance using relationship that she described as dysfunctional and characterized by blame, guilt, and differing parenting styles. The couple’s first pregnancy together was with B1 and B2, identical twins who were exposed to prenatal polysubstance use across all three trimesters (i.e., nicotine, alcohol, prescribed methadone). The twins were diagnosed with twin-to-twin transfusion syndrome, which resulted in an early cesarian delivery. Born prematurely and at a low birth weight, the twins exhibited neonatal abstinence syndrome and required postnatal interventions. After the birth of B1 and B2, mother B experienced post-partum depression. The family was under extreme financial distress and moved to a family support shelter.