Twin twin transfusion and fetomaternal transfusion

Abstract

Introduction: The authors describe a case of fetomaternal haemorrhage (FMH) with signiÞ cant fetal repercussions, after laser ablation of vascular connections in the shared placentae in a twin twin transfusion syndrome (TTTS).

Clinical case: 31 years old, healthy, first gestation, spontaneous, monochorionic diamniotic twin pregnancy.The 1st trimester ultrasound at 12 weeks gestation showed concordance of crown rump length (CRL) values, but discordance of the nuchal translucency (NT) measurements. The first trimester screening for trisomies 21, 18 and 13 by ultrasound and biochemical testing, was negative.

A TTTS was diagnosed at 16 weeks - stage II / III of Quintero. Amniocentesis revealed a normal male karyotype 46, XY of the donor fetus and a chromossomopathy 47, XYY of the receptor fetus.

At 17 weeks, laser ablation of placenta vascular anastomosis was performed, occurring the death of the donor fetus at 18 weeks.

At 22 weeks, fetal anemia by fetomaternal transfusion (FMT), confirmed by ß ow cytometry, was diagnosed.

By 26 weeks, a dilated bowel loop was noticed - suspicion of intestinal atresia.

Birth by cesarean at 37 weeks. New born: male, 2660g, Apgar index 5/8/10. Ileal atresia type II was conÞ rmed and segmental bowel resection was performed. Favourable posterior outcome.

Conclusion: This is a case of twin-twin transfusion syndrome, followed by fetomaternal transfusion with intestinal atresia, in probable association with fetal anaemia in a fetus with a chromosomopathy.