Rapid onset of severe twin-twin transfusion syndrome caused by placental venous thrombosis

Peter G. J. Nikkels, Martin J. C. van Gemert, Krystyna M. Sollie-Szarynska, Harry Molendijk, Bert Timmer, Geoffrey A. Machin

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Abstract

We report a case of rapid onset of severe twin-twin transfusion syndrome (TTTS) at 25 weeks gestation in a monochorionic twin pregnancy that was uneventful before that time. Thrombosis of a main venous branch draining several arteriovenous (AV) anastomoses to the donor changed the previous hemodynamic balance that existed between multiple bidirectional AV anastomoses. The opposing AVs became hemodynamically uncompensated and, despite amnioreductions, severe TTTS developed. At 27 weeks a cesarean section was performed because of worsening cardiotocography parameters of both fetuses. Birth weights were 750 and 1840 g, and initial hemoglobin concentrations were 9.2 and 13.4 mmol/liter for donor and recipient, respectively. The recipient twin died 5 months later of an ischemic, necrotic, and perforated small intestine due to a thrombosed superior mesenteric artery. The donor is well at 2.5 years. No abnormalities in several factors associated with thrombophilia, including factor V Leiden mutations, were found in the parents
Original languageEnglish
Pages (from-to)310-314
JournalPediatric and developmental pathology
Volume5
Issue number3
DOIs
Publication statusPublished - 2002

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