Journal of Health and Medical Sciences
Published: 22 April 2022
Optimizing Fetal Outcomes in Twin-Twin-Transfusion Syndrome using Serial Amnioreduction in Resource-Constrained Unit: A Case Report
Olufemi A Oloyede, Mustafa A Lamina, Tessie O Shorunmu
Olabisi Onabanjo University Teaching Hospital, Nigeria
Download Full-Text Pdf
Keywords: Twin-to-Twin Transfusion Syndrome, Serial Amnioreduction, Fetoscopic Laser Photocoagulation, Quintero Staging, Resource-Constrained Unit
Background: Twin-twin transfusion syndrome is an important complication of monochorionic placentation in twin pregnancy. The management of this condition in Nigeria and many other developing countries has always been “watchful expectancy” with attendant high perinatal morbidity and mortality. Amnioreduction is a less demanding treatment option compared with fetoscopic laser coagulation management option in terms of cost and expertise, but has not been reported from any unit in Nigeria. Case Presentation: A 28-year-old gravid 2 para 1+0, 1 alive, carrying twin pregnancy was referred at 22 weeks gestation with complaint of mild discomfort due to sudden rapid enlargement of the abdomen. Physical examination and ultrasound scan assessment confirm Quintero stage II Twin-twin transfusion syndrome and she underwent serial amnioreduction at 24, 28 and 31 weeks of gestation with satisfactory outcomes. She had caesarean section at 33 weeks due to an acute episode of severe maternal discomfort and was delivered of 2 live female babies. There were no adverse perinatal events. Conclusion: This case presented demonstrates the role of amnioreduction in the management of carefully selected cases of twin-twin transfusion syndrome and further encouraged its utilization. in resource-constrained units instead of ‘watchful expectancy’ and in the absence of fetoscopic laser photocoagulation
Osaghae DO, Unuigbe JA (2016). Transfusion syndromes in monochorionic multiplets: An overview. Trop J Obstet Gynaecol, 33: 135-42 http://doi:10.4103/0189-5117.192211
Simpson LL. (2012). Twin-twin transfusion syndrome. Am J Obstet. Gynaecol, 208(1): 3–18, http://doi: 10.1016/j.ajog.2012.10.880.
Xueju W, Pengbo Y, Ying W, Yangyu Z, Yuan W (2015). Placental characteristics of monochorionic twin pregnancy complicated with selective fetal growth restriction (Chinese). Chin J Perinat Med, 18(4):252-7 http:/doi:10.3760/cma.j.issn.1007/408.2015.04.002
Durbin SA. (2011). A Sonographer’s Perspective: Quintero Staging System for Twin-to-Twin Transfusion Syndrome in Monochorionic Twins. Journal of Diagnostic Medical Sonography,27:122–5. http://doi:10.1177/875649311402831
Bansal R, Kaur J, Priyanka. (2020). Twin-Twin transfusion syndrome: a case report. Int J Reprod Contracept Obstet Gynecol,9: 1282-4. http://dx.doi.org/10.18203/2321-1770
Salomon LJ, Ville Y. (2008). Twin-to-twin transfusion syndrome: diagnosis and treatment. Bull Acad. Natl. Med, 192(8):1575-86.
Sebire NJ, Souka A, Skentou H, Geerts L, Nicolaides KH (2010). Early prediction of severe twin-to-twin transfusion syndrome. Hum Reprod,15:2008-10.
Mylrea-Foley B, Shaw CJ, Harikumar N, Legg S and Meher S. (2019). Early-onset twin–twin transfusion syndrome: Case series and systematic review. AJUM, 22 (4): 286-94. http://doi.org/10.1002/ajum.12176
Couck I, Ponnet S, Thewissen L, Russo F, Deprest J, De Catte L, et al. (2021). The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination. Fetal Diagn Ther, 48(5): 353-60. http://doi: 10.1159/000514575
Prefumo F, Jauniaux E. (2018). Twin-to-twin-transfusion syndrome: from amniodrainage to laser. Br J Obstet Gynaecol, 125 (9):1163-1163.
Roberts D, Neilson JP, Kilby MD, (2014). Gates S. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 1. CD002073. http://doi: 10.1002/14651858.CD002073.pub2