J Korean Med Sci.  2009 Jun;24(3):513-516. 10.3346/jkms.2009.24.3.513.

A Case of Successful Selective Abortion Using Radio-frequency Ablation in Twin Pregnancy Suffering from Severe Twin to Twin Transfusion Syndrome

• Chang EM
• Park MH
• Kim YJ
• Kim JI
• Ahn JJ
• Chun SH

• KMID: 1779173
• DOI: http://doi.org/10.3346/jkms.2009.24.3.513

Abstract

Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared. We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester. The blood supply to donor twin was interrupted successfully at 19+2 weeks of gestation by minimally invasive radio-frequency cord ablation, under ultrasound guidance. The normal recipient twin was delivered successfully at 35 weeks of gestation and had no eventful neonatal course.

Keyword

Monochorionic Twins; Pregnancy Reduction, Multifetal; Radiofrequency Ablation

MeSH Terms

Abortion, Eugenic/*methods
Adult
*Catheter Ablation
Female
Fetofetal Transfusion/*diagnosis/ultrasonography
Gestational Age
Humans
Pregnancy
Twins
Twins, Monozygotic

Figure

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  Fig. 1 Echogenic lesion in umbilical cord during radio-frequency cord ablation procedure (arrows represent electrodes).

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  Fig. 2 Absent blood flow in the umbilical cord of the 2nd twin after radio-frequency cord ablation.

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  Fig. 3 Mild ventriculomegaly of surviving 1st fetus at 24+6 weeks of gestation.

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  Fig. 4 Findings of selectively terminated 2nd fetus after delivery at 35 weeks of gestation. Iatrogenic gastroschisis and mono-chorionic twin placenta of pregnancy are seen.

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