UMBILICAL ARTERY STEAL SYNDROME AND DISTAL GANGRENE IN A CASE OF TWIN-TWIN TRANSFUSION SYNDROME

Background: Vascular accidents in the survivor from pregnancies with t win-twin transfusion syndrome have been attributed to the release of t hromboplastin from the dead fetus. Case: In a woman presenting at 22 w eeks' gestation with acute polyhydramnios due to twin-twin transfusion syndrome, endoscopic laser coagulation of the communicating vessels w as performed. At endoscopy, the toes of the left foot of the recipient fetus were noted to be gangrenous. This fetus had only a left umbilic al artery, which was markedly dilated, and Doppler studies demonstrate d impaired perfusion of the left leg. In four control fetuses with a s ingle umbilical artery, Doppler studies demonstrated normal waveforms in both legs. Conclusion: In twin-twin transfusion syndrome, fetal per ipheral gangrene may occur before the death of one twin. The ischemic necrosis of the toes probably resulted from the combined effect of pol ycythemia and umbilical artery steal syndrome. Interruption of twin-tw in transfusion syndrome caused resolution of the polycythemia and prev ented further damage by removing one of the components of the peripher al ischemia.