S. Tanawattanacharoen et al., Intrauterine rescue transfusion in monochorionic multiple pregnancies withrecent single intrauterine death, PRENAT DIAG, 21(4), 2001, pp. 274-278
Citations number
27
Categorie Soggetti
Reproductive Medicine","Medical Research Diagnosis & Treatment
To assess the role of fetal blood sampling and intrauterine transfusion in
monochorionic (MC) multiple pregnancy complicated by single intrauterine de
ath (IUD). we reviewed ten cases over a 4-year period in a tertiary referra
l centre which underwent fetal blood sampling within 24 h of death of its M
C co-twin. Intrauterine rescue transfusion was performed in all seven anaem
ic fetuses (hematocrit; Hct < 30%) to raise the fetal Hct to greater than o
r equal to 40%. The rationale was to prevent death and/or brain injury. Two
fetuses. which were severely acidaemic at blood sampling, died in utero wi
thin 24 h of the procedure. In two cases, the surviving twins manifested ab
normal sonographic findings of the fetal brain 2-5 weeks later and underwen
t late termination. In two cases, the pregnancies continued uneventfully un
til delivery at 35 and 40 weeks' gestation with good neonatal outcome. In o
ne case the co-twin delivered 1 week later at 29 weeks but died within 12 h
. Fetuses without anaemia were not transfused and had normal clinical outco
mes. We suggest that intrauterine rescue transfusion before the development
of severe acidaemia in anaemic surviving MC co-twins may prevent fetal dea
th, but does not necessarily prevent brain injury. Until its role becomes c
learer, we recommend that its use be restricted to situations in which the
parents and the local jurisdiction allow late termination as an option if b
rain injury subsequently manifests on ultrasound. Copyright (C) 2001 John W
iley & Sons. Ltd.