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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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
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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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Fetoscopy , Fetoscopic laser photocoagulation , Multi-disciplinary care , Twin twin transfusion syndrome , Venous thromboemobilic disease
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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