Twin-twin transfusion syndrome: rapid development of severe hydrops of the donor following selective feticide of the hydropic recipient

Article Abstract:

A case of twin-twin transfusion syndrome in which selective feticide led to hydrops and death in the second fetus is discussed. Twin-twin transfusion syndrome occurs when blood is circulated from the donor twin to the recipient twin due to arteriovenous joining in the placenta. The syndrome is associated with a 56% to 100% fetal and newborn mortality rate. The donor twin usually suffers from anemia, growth retardation and a small or absent amount of amniotic fluid. A woman who was 22.7 weeks pregnant developed nausea, difficulty breathing and a significant increase in abdominal size. An ultrasound examination revealed that the recipient fetus had a condition known as hydrops, or an abnormal accumulation of fluid in the body, and was surrounded by an excess of amniotic fluid. The donor fetus had no evidence of hydrops. Amniotic fluid was removed to relieve the mother's respiratory problems, but it accumulated again five days later. Feticide of the donor twin was planned. Another ultrasound exam revealed an absence of movement in the recipient fetus indicating death of the recipient. Twenty-four hours later the donor fetus developed hydrops and labor was induced. Both twins were delivered stillborn.

Complications and side effects, Twins, Hydrops fetalis

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Physiology of isolated long-term variability of the fetal heart rate

Article Abstract:

Long-term variability in fetal heart rate (FHR) patterns may not be of pathological origin. Ten pregnant women who were not in labor, but had a history of variability in fetal heart rate, were studied for 20 minutes. Fetal heart rate was monitored with an actocardiograph and fetal movement was assessed using real-time ultrasonography. Bursts of variability in FHR patterns measured by the actocardiograph were associated with fetal breathing movements as documented by the ultrasonography. This association was noted in the absence of other fetal movements. In the case where other fetal movements are evident, they could possibly hide the breathing action associated with the pattern variability.

Measurement, Fetal heart rate

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