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2006-10-16-14 Twin-to-twin transfusion with corpus callosum lysis after co-twin death © Cuillier www.thefetus.net/


Twin-to-twin transfusion with corpus callosum lysis after co-twin death

Fabrice Cuillier, MD

Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France. Tél : 0262 90 55 22. Fax : 0262 90 77 30

 

Twin-to-twin transfusion syndrome is a complication of monochorionic twin pregnancies in which there is imbalance in the net flow of blood across the placental vascular communications from one fetus, the donor, to other, the recipient. Clinical manifestation can be variable, from mild to severe forms. Donor fetus suffers from hypovolemia and hypoxia and recipient fetus suffers from expanded blood volume and consequent heart failure. This can lead to death of recipient fetus. In such situation the surviving fetus can be also compromised by what used to be called "twin-embolization syndrome" and is now more properly considered a acute hypovolemic event. We describe a case of twin to twin transfusion syndrome with neurological repercussion of living fetus after co-twin death.

35-year-old patient (G5P3) first time presented in her 13th week of pregnancy with monochorionic, diamniotic twin pregnancy and normal ultrasound screening of the fetuses. Biochemical screening wasn’t done. At 20th week of pregnancy the ultrasonographic examination was normal. At 24th week of pregnancy we discovered death fetus with severe oligohydramnios and normal amniotic fluid amount around live fetus. Nevertheless we could see mild unilateral cerebral ventriculomegaly (atrial length 10 mm) and the cavum septum pellucidum and pericallosal artery weren’t present. The ventriculomegaly had been progressing and became bilateral. At 32nd week of pregnancy we performed magnetic resonance investigation that confirmed absence of corpus callosum.

We presume corpus callosum lysis after co-twin death.

After magnetic resonance investigation had been done, the patient decided to go to another institution, where the cesarian section was performed in 34th week of pregnancy (male baby, 2000 g.). By our knowledge the neurological development in first and third months of life was normal.

24th week of pregnancy - death fetus with severe oligohydramnios and mild cerebral ventricular dilatation of live fetus

Normal appearance of posterior fossa and absent cavum septum pellucidum of live fetus

Axial sections in 27th week of pregnancy showing bilateral ventriculomegaly of live fetus

Absence of corpus callosusm and pericallosal artery

MRI - absence of corpus callosum

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