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2019-12-08 Case of the week #511 © Grochal www.TheFetus.net 

Case of the week #511

January 02, 2020 - January 16, 2020

Frantisek Grochal, MD1; Karel Hodík, MD2; Viktor Tomek, MD, PhD3., Pavel Calda, MD, PhD4.

Femicare, Center of prenatal ultrasonographic diagnostics, Kollarova 17/A, 036 01 Martin, Slovak Republic;

2 University Hospital Hradec Králové, Department of Obstetrics and Gynecology, Sokolská 581, 500 05 Hradec Králové – Nový Hradec Králové, Czech Republic;

3 Department of echocardiography and prenatal cardiology, Children's Heart Centre, University Hospital Motol, V úvalu 84, Prague 150 06, Czech Republic;

4 Professor, Head of the Fetal Medicine Centre; Charles University in Prague, First Faculty of Medicine, Department of Gynaecology and Obstetrics of the First Faculty of Medicine and General Teaching Hospital, Apolinarska 18, 128 51, Praha 2, Czech Republic.


Case report

A 34-year-old woman (G1P0) with non-contributive history was sent to our facility at 19 weeks + 1 day of her monochorionic, diamniotic twin pregnancy. Our examination revealed twin-to-twin transfusion syndrome (TTTS) of the fetuses with following findings:


Twin A (XY, donor):

severe oligohydramnios “stuck twin”

bladder non-visualized

EFW 209 g ± 31 g


Twin B (XY, recipient):

polyhydramnios (DVP 85 mm)

overfilled bladder

tricuspid regurgitation

EFW 273 g ± 40 g


Image 01: Scheme showing relations of the placenta, insertions of the umbilical cords to the placenta, and position of the fetuses – donor (“stuck twin”) and recipient with polyhydramnios during our examination at 19 weeks and 1 day of pregnancy.


The findings were consistent with TTTS stage II (Quintero), or TTTS IIIa (Cincinnati staging system). 

The patient was sent to a specialized fetal medicine center in Prague, Czech Republic, and successful fetoscopic laser photocoagulation of placental anastomoses was done at 19 weeks + 6 days of pregnancy.


19 days after fetoscopic laser photocoagulation following findings were found in fetus A (former donor):


Image 02, video 01:

 

Image 03 and 04:

 

Image 05 and video 02:

 

Video 03 and image 09: FetalHQ speckle tracking analysis.




What is the name of the complication of the twin-to-twin transfusion syndrome described in the images and videos above?


When you have tried to solve the case on your own (no team work here please !) you can find the Answer here.

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