A double dilemma: treatment of stage IV fetal twin-twin transfusion syndrome in the setting of maternal recurrent venous thromoembolism: a case report

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Date
2019-10-24
Authors
McCarthy, Claire M.
al-Madhani, Alya
Smyth, Suzanne
Russell, Nóirín E.
Wimalasundera, Ruwan
O'Donoghue, Keelin
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BMC, Springer Nature
Published Version
10.1186/s12884-019-2551-9
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Abstract
Background: Fetal conditions can pose significant challenges in the management of pregnancies complicated by pre-existing maternal medical conditions. Case presentation: We report a case of a 34-year-old woman with Stage IV Twin Twin Transfusion syndrome in the presence of maternal recurrent complex venous thromboembolic disease. Following a previous pregnancy loss, complicated by a third episode of thromboembolic disease, an inferior vena cava filter was placed. One month later, a pregnancy was confirmed and subsequently identified as a monochorionic twin pregnancy. Twin-Twin Transfusion syndrome was identified at 18 weeks’ gestation and progressed rapidly to Quintero Stage IV. In consultation with a multi-disciplinary international team, fetoscopic laser photocoagulation was performed. The pregnancy progressed to delivery of female infants at 33 weeks gestation, who have achieved all developmental milestones at 2 years of age. Conclusions: We describe the multi-disciplinary effort to optimise the maternal condition to allow fetoscopic laser photocoagulation and continued management of the maternal and fetal conditions to a successful pregnancy outcome.
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Keywords
Fetoscopy , Fetoscopic laser photocoagulation , Multi-disciplinary care , Twin twin transfusion syndrome , Venous thromboemobilic disease
Citation
McCarthy, C. M., al-Madhani, A., Smyth, S., Russell, N. E., Wimalasundera, R. and O’Donoghue, K. (2019) 'A double dilemma: treatment of stage IV fetal twin-twin transfusion syndrome in the setting of maternal recurrent venous thromoembolism: a case report', BMC Pregnancy and Childbirth, 19(1), 377. (4.pp.) doi: 10.1186/s12884-019-2551-9
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https://hdl.handle.net/10468/9307
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INFANT Research Centre - Journal Articles
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©The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.