Ries M, Beinder E, Grüner C, Zenker M
Department of Pediatrics, University of Erlangen-Nürnberg, Germany.
J Perinat Med. 1999;27(1):68-73. doi: 10.1515/JPM.1999.008.
Intrauterine death of one fetus in monochorionic twinning is associated with high rates of perinatal morbidity and mortality in the surviving fetus. Subsequent development of hydrops fetalis in the donor twin after fetal demise of the recipient twin has been described in only two case reports and pathophysiology remains unclear. We report on a monochorionic-diamniotic twin pregnancy complicated by severe twin-twin transfusion syndrome. Ultrasound examination at 20 weeks of gestation showed discrepant twins with oligohydramnios in the smaller twins' sac and polyhydramnios in that of the larger twin. Repeated amniocenteses permitted prolongation of the pregnancy. However, the recipient twin developed deteriorating hydrops fetalis and died at 28 weeks of gestation. After this event, subsequent development of hydrops fetalis in the surviving donor twin could be observed, as well as an increase of amniotic fluid. An elective cesarean section was performed at 29 weeks of gestation. Initial hypoxemia could be effectively treated by high frequency oscillatory ventilation, surfactant therapy and inotropic support. The infant was discharged in good condition at the age of 2 months. Although rare, antenatal demise of the recipient twin in a monochorionic pregnancy can be associated with the subsequent development of hydrops fetalis in the surviving donor twin. We speculate that this phenomenon is due to ischemia-reperfusion injury of the previously poorly perfused twin.
单绒毛膜双胎妊娠中一个胎儿的宫内死亡与存活胎儿的围产期发病率和死亡率高相关。在仅两篇病例报告中描述了受血儿双胎胎儿死亡后供血儿双胎随后发生胎儿水肿的情况,其病理生理学仍不清楚。我们报告一例单绒毛膜双羊膜囊双胎妊娠并发严重双胎输血综合征。妊娠20周时超声检查显示双胎大小不一致,较小胎儿羊膜腔内羊水过少,较大胎儿羊膜腔内羊水过多。反复羊膜腔穿刺术使妊娠得以延长。然而,受血儿双胎发生胎儿水肿逐渐加重,于妊娠28周死亡。此事件后,可观察到存活的供血儿双胎随后发生胎儿水肿,以及羊水增多。在妊娠29周时进行了择期剖宫产。初始低氧血症通过高频振荡通气、表面活性剂治疗和强心支持得以有效治疗。婴儿在2个月大时状况良好出院。虽然罕见,但单绒毛膜妊娠中受血儿双胎的产前死亡可能与存活的供血儿双胎随后发生胎儿水肿有关。我们推测这种现象是由于先前灌注不良的双胎发生缺血再灌注损伤所致。