Z Geburtshilfe Neonatol 2011; 215 - PO06_09
DOI: 10.1055/s-0031-1293368

Vascular limb occlusion in severe twin-to-twin transfusion syndrome (TTTS)

S Schrey 1, A Huber 2, K Hecher 3, R Quintero 4, K Moise 5, G Ryan 1
  • 1Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Kanada
  • 2Praenatalmedizin Muenchen, Munchen
  • 3Uniklinik Hamburg Eppendorf, Geburtshilfe, Hamburg
  • 4Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A.
  • 5Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, Houston, Texas, U.S.A.

Ziel: To evaluate the phenomenon of vascular limb occlusion in severe twin-to-twin transfusion syndrome (TTTS).

Methodik: Multi-centre retrospective review of cases of limb necrosis found in association with severe TTTS

Ergebnis: 18 cases of limb necrosis in association with severe TTTS were identified from 8 fetal medicine centers. Mean gestational age at diagnosis of TTTS was 21.5 wks (16–26) and at delivery was 29.4 wks (20–35.8). 16 of the 18 cases received treatment (9 laser and amnioreduction, 7 only amnioreduction). In the two untreated cases one and two fetuses were already dead when the patient presented for treatment. Of the 9 cases treated with laser, limb injury was already present in 5 cases at time of fetoscopy/laser. 17 recipient twins were affected and one donor. Lower limbs were affected more often than upper (15 versus 3), and right more than left (12 versus 5, one bilateral). The extent of the damage correlated with severity of TTTS: Of the six cases with lower limb injury above the knee four were in stage IV, one in stage III, and one in stage II. Of the nine cases with milder lower limb injury below the knee four occurred in stage III, four in stage II, and one in stage I. All cases of injury in the upper limb were milder. Postnatal or fetal hematocrit/hemoglobin was available in seven patients. In four the recipient was polycythemic, in one the donor. Review of the literature revealed 19 previously published cases of ischemic limb injury.

Schlussfolgerung: Peripheral limb necrosis is a rare complication of TTTS. In contrast to previous suggestions, it is unrelated to and precedes any treatment with either laser ablation or amnioreduction. Lesions tend to occur more often in severe hydropic recipients. We suggest that polycythemia and vasconstriction/hypertension are the primary factors causing an increased rate of ischemic events in recipients.

MC twin - Vascular limb occlusion - twin-to-twin transfusion syndrome (TTTS)