Department of Obstetrics and Gynecology, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong, Special Administrative Region of China.
Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, Hong Kong, Special Administrative Region of China.
BMC Pregnancy Childbirth. 2019 Aug 27;19(1):311. doi: 10.1186/s12884-019-2459-4.
Monochorionic multifetal pregnancies are at increased risk of adverse perinatal outcome because of placental vascular anastomoses. We present a case of multicystic encephalomalacia and gastrointestinal injury in two surviving fetuses following single fetal death in first trimester and subsequent fetofetal transfusion syndrome in a monochorionic triplet pregnancy.
A 31-year-old nulliparous woman had a spontaneous monochorionic triamniotic triplet pregnancy. Three live fetuses with single placenta were seen at 8-week ultrasound scan. One fetus demised at 11 weeks and 3 days of gestation. Dilated echogenic bowel and ascites were found in one surviving fetus at 23 weeks of gestation. At 28 weeks of gestation, the pregnancy was complicated by fetofetal transfusion syndrome in which discordant amniotic fluid volumes were found. Two days later, emergency Caesarean section was performed because of worsening of fetal Doppler and biophysical profile. One baby was found to have jejunal atresia requiring surgery at 4 days old. He had periventricular leukomalacia and intracranial haemorrhage, but subsequent normal neurological development. Another baby had gastric perforation requiring surgery at 2 days old. He was confirmed to have multicystic encephalomalacia by cranial ultrasound and magnetic resonance imaging. He suffered from developmental delay, epilepsy and cerebral palsy.
This case alerts the obstetricians the possible hypoxic-ischemic injury to the survivors of monochorionic triplet pregnancy after the co-triplet death in the first trimester and fetofetal transfusion syndrome. Antenatal assessment and postnatal follow-up are important for these high-risk multiple pregnancies.
由于胎盘血管吻合，单绒毛膜多胎妊娠的围产期不良结局风险增加。我们报告了一例三绒毛膜三胎妊娠中一胎在孕早期死亡后发生的两存活胎儿多囊性脑软化和胃肠道损伤，以及随后发生的单绒毛膜三胎妊娠胎儿-胎儿输血综合征。
一位 31 岁的初产妇，自然妊娠单绒毛膜三羊膜囊三胎。在 8 周超声检查时可见 3 个活胎，共用一个胎盘。孕 11 周 3 天时，其中一胎死亡。孕 23 周时，其中一存活胎儿发现扩张性回声肠管和腹水。孕 28 周时，妊娠并发胎儿-胎儿输血综合征，发现羊水容量不一致。两天后，由于胎儿多普勒和生物物理评分恶化，行紧急剖宫产术。一名婴儿发现空肠闭锁，在 4 天大时需要手术。他患有脑室周围白质软化和颅内出血，但随后神经发育正常。另一名婴儿在 2 天大时发现胃穿孔，需要手术。头颅超声和磁共振成像证实他患有多囊性脑软化。他患有发育迟缓、癫痫和脑瘫。
本病例提醒产科医生，在孕早期三胎妊娠中的一胎死亡和胎儿-胎儿输血综合征后，单绒毛膜三胎妊娠的幸存者可能会发生缺氧缺血性损伤。对这些高危多胎妊娠进行产前评估和产后随访非常重要。
