Twin to Twin Transfusion Syndrome
DOI:
https://doi.org/10.25077/aoj.6.2.191-197.2022Keywords:
twin to twin transfusion syndrome, ultrasonography, monochorionAbstract
Introduction: Collateral arterial growth is an effective adaptation process to maintain blood supply in myocardial tissue distal to a coronary stenosis and in other vascular beds where feeding arteries are obstructed (1) . The drive for outgrowth and remodelling of arterial collaterals is an increased shear stress due to an enlarged blood flow occurring after the event of stenosis in a near by conduit artery. Remodelling includes increased growth of the diameter and length of the collateral, causing the characteristic tortuous or cork screw appearance (1) .Whilst collateral growth is generally beneficial, we will present evidence that arterial collateral out growth occurred in a monochorionic twin placenta where it jeopardised the pregnancy by causing the twin to twin transfusion syndrome (TTTS).
Objective: to report a case of twin-to-twin transfusion
Case Report: Reporting a case experienced and taken care in our Clinic Fetomaternal RS. Dr .M. Jamil Hospital. A 34 years old woman, gravida 2, para1, at 31 weeks and 6 days amenorrhea, because her pregnant uterus was too large for gestational Referral to tertiary center followed. At 32 weeks and 2 days amenorrhea biometry indicated estimated fetal weights of 1950 and 1450 g (Hadlock), oligohydramnios and polyhydramnios (amniotic fluid index:23cm. No structural anomaly of the heart was seen. No interventions, one course of corticosteroids were administered for fetal lung maturation. At 33 weeks a slight decrease in heart rate variability of the smaller twin was observed. A Caesarean section under spinal anesthesia was performed. Two girls were delivered of 1585 g and 2135 g and in good condition (Apgar scores 8 and 9 after 1 and 5 min in both girls). The monochorionic diamniotic placenta weighed 740 g. The cord of the recipient was centrally inserted and that of the donor velamentally. Placenta was born monochorion, diamnion.
Conclusion: TTTS is caused due to unidirectional deep arteriovenous (AV) anastomoses with the superficial short comings. Hypovolemia, oliguria and oligohydramnion occurs in the donor fetus. Hypervolemia, polyuria and polyhydramnios occurs in the recipient fetus
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Joserizal Serudji
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright
Authors who publish with this journal agree to the following terms:
- Authors retain the copyright of published articles and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
License:
Andalas Obstetrics and Gynecology Journal (AOJ) is published under the terms of the Creative Commons Attribution 4.0 International License. This license permits anyone to copy and redistribute this material in any form or format, compose, modify, and make derivatives of this material for any purpose, including commercial purposes, as long as they credit the author for the original work.
