Ferreira Sofia Almeida, Januário Gustavo Machado Guimarães, Pereira Dolores Faria, Silva Isabel Santos, Negrão Fatima
Hospital Pediátrico de Coimbra, Coimbra, Portugal.
BMJ Case Rep. 2011 Jun 9;2011:bcr0220113922. doi: 10.1136/bcr.02.2011.3922.
The presence of acute peripartum anaemia in a monochorionic twin pregnancy represents a clinical challenge requiring prompt recognition and management. Twin-to-twin transfusion syndrome (TTTS) is a major complication of these pregnancies and a medical emergency in its acute form. Acute intrapartum fetoplacental transfusion (AIFT) has been reported infrequently. The authors present a case of a probable acute TTTS in an uneventful monochorionic monoamnionic twin pregnancy, where typical ultrasound criteria for long-standing TTTS were absent. The first twin was born pale, hypotonic and developed hypovolemic shock due to acute anaemia. Soon after birth, she presented with seizures and a cerebral ultrasound detected a large parieto-occipital infarction. The second twin, although plethoric, was clinically well. The risk of acute TTTS and AIFT, although infrequent and unpredictable, should be kept in mind when planning delivery of monochorionic twins, because the consequences for one or both twins can be disastrous.
单绒毛膜双胎妊娠合并急性围产期贫血是一项临床挑战，需要迅速识别并进行处理。双胎输血综合征（TTTS）是这类妊娠的主要并发症，急性形式属于医疗急症。急性分娩期胎儿-胎盘输血（AIFT）的报道较少。作者报告了一例单绒毛膜单羊膜囊双胎妊娠，过程平稳，但可能发生了急性TTTS，其中不存在长期TTTS的典型超声标准。第一个胎儿出生时面色苍白、肌张力低下，因急性贫血出现低血容量性休克。出生后不久，她出现惊厥，脑部超声检查发现顶枕叶大面积梗死。第二个胎儿虽然面色红润，但临床情况良好。在计划单绒毛膜双胎分娩时，应牢记急性TTTS和AIFT的风险，尽管这种情况罕见且不可预测，但对一个或两个胎儿的后果可能是灾难性的。
