A case of late-onset twin-twin transfusion syndrome with severe fetal anemia and maternal acute kidney injury
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253105Keywords:
Twin-twin transfusion syndrome, Acute kidney injury, Laser coagulation.Abstract
Twin-twin transfusion syndrome (TTTS) is a rare but serious complication of monochorionic twin gestation which forewarns obstetricians about the best management approach. The majority of cases are diagnosed early and managed with laser coagulation, resulting in reduced neonatal mortality. We have managed a late-diagnosis of TTTS Quintero stage 1, who was delivered due to suspicion of severe fetal anemia in the donor and cardiac overload in the recipient twin. The mother developed acute kidney injury in the early third trimester which worsened despite appropriate management. The cause of kidney injury in a mother carrying monochorionic diamniotic (MCDA) twins is unknown, yet restoration of renal function post-delivery suggests a connection. We are presenting this case as a rare presentation of severe fetal anemia in TTTS. This case demands additional research to identify the triggering factors, knowledge of which is expected to reformulate the management of MCDA twins.
Metrics
References
Society for Maternal-Fetal Medicine, Simpson LL. Twin-twin transfusion syndrome. Am J Obstet Gynecol. 2013;208(1):3-18. DOI: https://doi.org/10.1016/j.ajog.2012.10.880
Fisher KE, Welsh AW, Wilson I, Henry A. Uncommon complications of monochorionic twin pregnancies: Twin anaemia-polycythaemia sequence. AJUM. 2016;19(2):56-63. DOI: https://doi.org/10.1002/ajum.12013
Dekonink P, Deprest J, Lewi P, Richer J, Galjaard S, Van Keirsblick J, et al. Gestational age-specific reference ranges for amniotic fluid assessment in monochorionic diamniotic twin pregnancies. Ultrasound Obstet Gynecol. 2013;41(6):649-52. DOI: https://doi.org/10.1002/uog.12387
Bronacha MF, Caroline JS, Nirupama H, Sophie L, Shireen M, Christoph CL. Early-onset twin–twin transfusion syndrome: Case series and systematic review. AJUM. 2019;22(4):286-94. DOI: https://doi.org/10.1002/ajum.12176
Mascio DD, Khalil A, D’Amico A, Buca D, Benedetti PP, Flacco ME, et al. Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2020;56(6):811-20. DOI: https://doi.org/10.1002/uog.22054
Krispin E, Javinani A, Odibo A, Carreras E, Emery SP, Sepulveda G, et al. Consensus protocol for management of early and late twin–twin transfusion syndrome: Delphi study. Ultrasound Obstet Gynecol. 2024;63(3):371-7. DOI: https://doi.org/10.1002/uog.27446
Filomena GS, Francesco D, Benlioglu C, Bhide A, Khalil A. Perinatal outcomes of twin pregnancies complicated by late twin-twin transfusion syndrome: A systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2021;100(5):832-42. DOI: https://doi.org/10.1111/aogs.14066
Huber A, Diehl W, Zikulnig L, Bregenzer T, Hackeloer BJ, Hecher K. Perinatal outcome in monochorionic twin pregnancies complicated by amniotic fluid discordance without severe twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2006;27(1):48-52. DOI: https://doi.org/10.1002/uog.2655
Rana S, Michele R, Hacker, Modest AM, Salahuddin S, Lim KH, Verlohren S, et al. Circulating angiogenic factors and risk of adverse maternal and perinatal outcomes in twin pregnancies with suspected preeclampsia. Hypertension. 2012;60(2):451-58. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.112.195065
Downloads
Published
How to Cite
Issue
Section
