Twin-twin transfusion syndrome

Article Abstract:

Twins that are supported by a single placenta may, in some cases, actually share circulating blood when abnormal vascular connections develop in the placenta; this is known as fetofetal transfusion. In such cases, the donor twin becomes anemic, loses fluids, grows more slowly, and develops oligohydramnios (insufficient fluid in the amniotic sac, where the fetus floats). The recipient twin, conversely, develops an excess level of red blood cells (polycythemia), increased body fluids, and polyhydramnios (excess amniotic fluid). The prognosis in such cases is dismal, with virtually 100 percent mortality. To evaluate the effectiveness of a treatment method using amniocentesis (removal of excess amniotic fluid from the polyhydramniotic twin), records from 19 twin pregnancies complicated by twin-twin transfusion syndrome were reviewed. The patients were divided into four groups: group 1, no special intervention (five women); group 2, patients in premature labor when serial amniocenteses were started (four women); group 3, patients with twin-twin transfusion syndrome where one twin died during gestation (five), with amniocenteses of the remaining twin's sac in two cases; and group 4, patients who underwent repeated amniocenteses. Fetal survival rates for the four groups were none, 25 percent, 30 percent, and 60 percent, respectively. The two group 2 infants who survived were 29 weeks' gestational age at the time of delivery, and their survival was not a result of amniocentesis during labor. Initiation of this method is recommended when polyhydramnios in twin pregnancies first develops, between 16 and 21 weeks' gestation. The approach can be effective in a significant proportion of pregnancies complicated by this rare syndrome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Fetofetal transfusion, Pregnancy, Complications of, Pregnancy complications, Amniocentesis

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Oligohydramnios in each sac of a triplet gestation caused by Motrin - fulfilling Kock's postulates

Article Abstract:

To stop premature contractions during pregnancy, drugs can be administered to inhibit prostaglandin, a hormone-like substance that relaxes smooth muscle. Indomethacin, an antiprostaglandin drug, has many gastrointestinal side effects. Ibuprofen is another agent that inhibits the formation of prostaglandins. Oral ibuprofen (Motrin) was given to a 29-year-old woman experiencing early labor while pregnant with triplets. Previous attempts with terbutaline, an agent commonly used to stop contractions, failed. She received 600 mg of Motrin every six hours. Magnesium sulfate was given to control labor contractions, which increased in severity two days later. Motrin was then resumed, followed by another attempt with magnesium sulfate. On the 20th day of hospitalization, ultrasound evaluation revealed a decreased amount of the fluid surrounding the fetus. Normal fluid volume returned five days after the Motrin was discontinued. Another attempt with Motrin decreased the fluid again. The patient remained on terbutaline for the remainder of the hospitalized pregnancy and maintained the pregnancy, which was delivered at 35 weeks by elective cesarean section. This reduction in fluid after Motrin administration is a rare occurrence. Although Motrin decreased the amniotic fluid, it was reversible. Frequent (once or twice a week) ultrasonographic evaluation is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Physiological aspects, Premature labor, Ibuprofen, Motrin (Medication)

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Biophysical profile testing as an indicator of fetal well-being in high-order multiple gestations

Article Abstract:

Modified biophysical profile testing appeared to allow timely intervention in triplet and quadruplet pregnancies. Complications of multiple pregnancies of this kind can be dangerous to the mother as well as the fetuses. A biophysical profile evaluates fetal well-being by scoring fetal breathing movements, gross fetal body movements, fetal muscle tone, and amniotic fluid volume as seen on ultrasound. The usual electronic fetal monitoring of fetal heart-rate was omitted because of technical difficulties monitoring higher-order multiple gestations. Eighteen triplet and 6 quadruplet pregnancies were monitored twice weekly beginning at 28 weeks gestation. All babies were born alive. Six pregnancies were delivered because of abnormal test scores and worsening medical complications. All of these babies were born in good condition. Babies from four pregnancies delivered for medical complications were in poor condition at birth despite high biophysical profile scores. One of these babies, a severely growth retarded infant from a pregnancy delivered at 31 weeks 4 days, subsequently died. Delivery is recommended at or beyond 30 weeks gestation for even one compromised baby. Before this time, the risks to the other babies must be weighed.

Evaluation, Fetal monitoring

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