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İkizden İkize Transfüzyon Sendromu (TTTS) nedeniyle uygulanan amniyodrenaj sonrası ablasyo plasenta gelişimi

Year 2017, Volume: 80 Issue: 3, 120 - 124, 01.09.2017
https://doi.org/10.18017/iuitfd.332870

Abstract

ABSTRACT:

Twin to twin transfusion syndrome(TTTS)  is the unique complication of monochorrionic twin pregnancies. TTTS is the wellknown reason of perinatal mortality and morbidity in monochorrionic pregnancies. Fetoscopic laser ablasion is the first step treatment but some selected cases amniodrenaje can be used. We introduce an ablation placenta case after amniodrenaje in monochorrionic diamniotic  twin pregnancy. 37-year-old gravida 4 parite 3  26 weeks spontanous  pregnant women reffered to our clinic for monochorrionic diamniotic twin pregnancy. Ultrasonographic examianation was done  as  we found that one of the twin amnios is polyhydramnios and the others is olygohydramnios. We saw each bladders of twin. We suspect  Quintero stage 1 TTTS. Amniodrenaje is the appropriate choice cause of the time of pregnancy. We performed amniodrenaje  with a vacuum aspiraration device. While this procedure there was no bleeding in amnios fluid and we see each cardiac activity. After 15 minutis later abondane vaginal bleeding and uterine contractions occurs. We suspect ablation placenta and emergent cesarian section was done. Monochorrionic twin pregnancies that are complicated TTTS amniodrenje can be used in selected cases. This procedure has some rare complications as ablation placenta, pretem delivery, preterm rupture of membranes. There is no consequences in drenaje volüme and speed and some randomize controlled studies needed.

 

ÖZET:

İkizden ikize transfüzyon sendromu (TTTS) monokoryonik ikiz gebeliklere özgü bir komplikasyon olup perinatal morbidite ve mortalitenin önemli bir nedenidir. Fetoskopik lazer fotokoagülasyon TTTS olgularında ilk seçenek tedavi olmasına rağmen seçilmiş hasta grubunda amniyoredüksiyonun halen uygulanmaktadır. Burada TTTS nedeniyle amniyodrenaj yapılan ve işleme bağlı ablasyo plasenta gelişen vakamızı sunmayı amaçladık. 37 yaşında G4P3 hasta son adet tarihine göre 26 hafta 4 günlük spontan monokoryonik-diamniyotik ikiz gebelik nedeniyle dış merkezden tarafımıza refere edildi.  Yapılan ultrasonografik değerlendirmede alıcı fetüsün amniyotik sıvısı en derin tek cepte 14 cm (polihidramniyos) verici fetüsün amniyotik sıvısı en derin tek cepte 1 cm (oligohidramniyos) Verici fetüsün mesanesi gözlendi. Bu bulgularla Quintero evre 1 TTTS tanısı konuldu. Hastaya ileri gebelik haftası nedeniyle laser fotokoagulasyon işlemi uygulanamayacağı, seri amniyodrenaj işlemleri ile solunum sıkıntısının rahatlatılmaya ve preterm doğum riskinin azaltılmaya çalışılacağı anlatıldı. Alıcı fetüsün kesesine giriş sırasında ultrasonografi kılavuz olarak kullanıldı ve intertwin membrandan uzak bir bölge tercih edildi. Gelen amniyotik sıvının berrak olduğu görüldü. Spinal iğne, serum seti vasıtasıyla elektronik vakum  (Karl Storz Tutlingten, ALMANYA) cihazına bağlandı ve 30 dakikada 80-100 cc/dakika hızla toplam 2800 cc amniyodrenaj yapıldı. İşlem süresi boyunca amniyotik sıvıda kanama görülmedi ve işleme son verildi. İşlem sonrası alıcı fetüsün en derin vertikal tek cep ölçümü 7 cm ölçüldü ve her iki fetüsün kardiyak aktiviteleri izlendi. Hasta ağrısının ve solunum sıkıntısının azaldığını ifade etti. Amniyoredüksiyon işleminin sonlanmasından 15 dakika sonra hastada abondan vajinal kanama başladı ve uterusun kontrakte olduğu görüldü. Ablasyo plasenta ön tanısıyla acil sezaryen kararı verildi ve birinci fetüs 4/4 Apgarlı entübe 900 gr erkek bebek ve ikinci Fetüs 740 gr 4/5 Apgarlı entübe erkek bebek doğurtuldu. TTTS ile komplike olmuş monokoryonik ikiz gebeliklerde amniyodrenaj halen seçilmiş hasta grubunda tercih edilebilecek bir tedavi yöntemidir. İşleme bağlı ablasyo plasenta, preterm doğum, PPROM gibi komplikasyonların düşük oranda da olsa görülebileceği akılda tutulmalıdır. En fazla ne kadar sıvı boşaltılabileceği ve boşaltım hızıyla ilgili daha fazla çalışmaya ihtiyaç vardır.

 

(Corresponding author/İletişim kurulacak yazar: gurcanturkyılmaz@gmail.com)

References

  • 1. Berghella V, Kafmann M. Natural history of twin-twin transfusion syndrome. The Journal of Reproductive Medicine 2001; 46,480-4
  • 2. Roberts D, Neilson J.P, Kilby M, Gates S. İnterventions for twin-twin transfusion syndrome. Cochrane Databese of Systemic Reviews 1 2014 CD002073
  • 3. Baschat AA, Barber J, Pedersen N, Turan OM, Harman CR. Outcome after fetoscopic selective laser ablation placental anastomoses vs equatorial laser dichorionization fort he treatment of twin-to –twin transfusion syndrome. Am. J. Obstet. Gynecol 2013; 209-34
  • 4. ISUOG Practice Guidlines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47: 247-63
  • 5. Mari G, Roberts A, Detti L. Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome. Results of the international amnioreduction registery. Am. J. Obstet. Gynecol 2001; 185, 708-15
  • 6. Lutfi S, Allen VM, Fahey J. Twin-twin transfusion syndrome: a population-based study. Obstet-Gynecol 2004; 104:1289
  • 7. Wee LY, Sullivan M, Humphries K, Fisk NM. Longitudinal blood flow in shared (arteriovenous anastomoses) and non-shared cotyledons in monochorionic placentae. Placenta 2007; 28: 516-22
  • 8. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J. Perinatol 1999; 19: 550-5
  • 9. Simpson Lynn L. Twin-twin transfusion syndrome. SMFM Clinical Guidline Jan. 2013
  • 10. Emery SP, Hasley SK, Catov JM, Miller RS et al. North American Fetal Therapy Network: intervention vs expectant management for stage 1 twin-twin transfusion syndrome. Am. J. Obstet. Gynecol 2016; 215: 346-53
  • 11. Khalil A, Cooper E, Townsend R, Thilaganathan B. Evolution of stage 1 twin-to-twin transfusion sydrome (TTTS): Systematic review and meta-analysis. Twin Research and Human Genetics 2016; 33: 207-16
  • 12. Molina S, Papanna R, Moise KJ, Johnson A. Management of stage 1 twin-to-twin transfusion syndrome: an international survey. Ultrasound Obstet Gynecol 2010; 36: 42-7
  • 13. Moise Jr KJ, Dorman K, Lamvu G, Saade G, Fisk N. Arandomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. Am. J. Obstet. Gynecol 2005; 193: 701-7
  • 14. Bebbington M.W, Tiblad E, Huesler-Charles M, Wilson R.D, Mann S.E, Johnson M.P. Outcomes in a cohort of patients with Stage 1 twin-to-twin transfusion syndrome Ultrasound Obstet Gynecol 2010; 36: 48-51
  • 15. Fichera A, Lanna M, Fratelli N, Rustico M, Frusca T. Twin-to-twin transfusion syndrome presenting at early stages: is there still a possible role for amnireduction?. Prenat Diagn 2010; 30: 144-8
  • 16. Thompson A, Mone F, McComiskey M, Ong S. Amnioreduction in a singleton pregnancy: A systematic review. Journal of Obstetrics and Gynecology 2013; 33:8, 764-7
  • 17. Kleine R.T, Bernardes LS, Carvalho MA, Krebs V.L, Francisco R.P. Pregnancy outcomes in severe polihydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress. J. Matern Fetal Neonatal Med. 2016; 29: 4031-4
  • 18. Dickinson JE, Tjioe YY, Jude E. Amnioreduction in the management of polyhydramnios complicating syngleton pregnancies. Am. J. Obstet Gynecol. 2014; 211

Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS)

Year 2017, Volume: 80 Issue: 3, 120 - 124, 01.09.2017
https://doi.org/10.18017/iuitfd.332870

Abstract

ABSTRACT:






















Twin to twin transfusion syndrome(TTTS)  is the unique complication of monochorrionic
twin pregnancies. TTTS is the wellknown reason of perinatal mortality and
morbidity in monochorrionic pregnancies. Fetoscopic laser ablasion is the first
step treatment but some selected cases amniodrenaje can be used. We introduce
an ablation placenta case after amniodrenaje in monochorrionic diamniotic  twin pregnancy. 37-year-old gravida 4 parite
3  26 weeks spontanous  pregnant women reffered to our clinic for
monochorrionic diamniotic twin pregnancy. Ultrasonographic examianation was
done  as 
we found that one of the twin amnios is polyhydramnios and the others is
olygohydramnios. We saw each bladders of twin. We suspect  Quintero stage 1 TTTS. Amniodrenaje is the
appropriate choice cause of the time of pregnancy. We performed
amniodrenaje  with a vacuum aspiraration
device. While this procedure there was no bleeding in amnios fluid and we see
each cardiac activity. After 15 minutis later abondane vaginal bleeding and
uterine contractions occurs. We suspect ablation placenta and emergent cesarian
section was done. Monochorrionic
twin pregnancies that are complicated TTTS amniodrenje can be used in selected
cases. This procedure has some rare complications as ablation placenta, pretem
delivery, preterm rupture of membranes. There is no consequences in drenaje
volüme and speed and some randomize controlled studies needed.

References

  • 1. Berghella V, Kafmann M. Natural history of twin-twin transfusion syndrome. The Journal of Reproductive Medicine 2001; 46,480-4
  • 2. Roberts D, Neilson J.P, Kilby M, Gates S. İnterventions for twin-twin transfusion syndrome. Cochrane Databese of Systemic Reviews 1 2014 CD002073
  • 3. Baschat AA, Barber J, Pedersen N, Turan OM, Harman CR. Outcome after fetoscopic selective laser ablation placental anastomoses vs equatorial laser dichorionization fort he treatment of twin-to –twin transfusion syndrome. Am. J. Obstet. Gynecol 2013; 209-34
  • 4. ISUOG Practice Guidlines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47: 247-63
  • 5. Mari G, Roberts A, Detti L. Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome. Results of the international amnioreduction registery. Am. J. Obstet. Gynecol 2001; 185, 708-15
  • 6. Lutfi S, Allen VM, Fahey J. Twin-twin transfusion syndrome: a population-based study. Obstet-Gynecol 2004; 104:1289
  • 7. Wee LY, Sullivan M, Humphries K, Fisk NM. Longitudinal blood flow in shared (arteriovenous anastomoses) and non-shared cotyledons in monochorionic placentae. Placenta 2007; 28: 516-22
  • 8. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J. Perinatol 1999; 19: 550-5
  • 9. Simpson Lynn L. Twin-twin transfusion syndrome. SMFM Clinical Guidline Jan. 2013
  • 10. Emery SP, Hasley SK, Catov JM, Miller RS et al. North American Fetal Therapy Network: intervention vs expectant management for stage 1 twin-twin transfusion syndrome. Am. J. Obstet. Gynecol 2016; 215: 346-53
  • 11. Khalil A, Cooper E, Townsend R, Thilaganathan B. Evolution of stage 1 twin-to-twin transfusion sydrome (TTTS): Systematic review and meta-analysis. Twin Research and Human Genetics 2016; 33: 207-16
  • 12. Molina S, Papanna R, Moise KJ, Johnson A. Management of stage 1 twin-to-twin transfusion syndrome: an international survey. Ultrasound Obstet Gynecol 2010; 36: 42-7
  • 13. Moise Jr KJ, Dorman K, Lamvu G, Saade G, Fisk N. Arandomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. Am. J. Obstet. Gynecol 2005; 193: 701-7
  • 14. Bebbington M.W, Tiblad E, Huesler-Charles M, Wilson R.D, Mann S.E, Johnson M.P. Outcomes in a cohort of patients with Stage 1 twin-to-twin transfusion syndrome Ultrasound Obstet Gynecol 2010; 36: 48-51
  • 15. Fichera A, Lanna M, Fratelli N, Rustico M, Frusca T. Twin-to-twin transfusion syndrome presenting at early stages: is there still a possible role for amnireduction?. Prenat Diagn 2010; 30: 144-8
  • 16. Thompson A, Mone F, McComiskey M, Ong S. Amnioreduction in a singleton pregnancy: A systematic review. Journal of Obstetrics and Gynecology 2013; 33:8, 764-7
  • 17. Kleine R.T, Bernardes LS, Carvalho MA, Krebs V.L, Francisco R.P. Pregnancy outcomes in severe polihydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress. J. Matern Fetal Neonatal Med. 2016; 29: 4031-4
  • 18. Dickinson JE, Tjioe YY, Jude E. Amnioreduction in the management of polyhydramnios complicating syngleton pregnancies. Am. J. Obstet Gynecol. 2014; 211
There are 18 citations in total.

Details

Subjects Health Care Administration
Journal Section Case Reports
Authors

Gürcan Türkyılmaz

Emircan Ertürk

Tuğba Saraç Sivrikoz This is me

İbrahim Halil Kalelioğlu

Publication Date September 1, 2017
Submission Date August 5, 2017
Published in Issue Year 2017 Volume: 80 Issue: 3

Cite

APA Türkyılmaz, G., Ertürk, E., Saraç Sivrikoz, T., Kalelioğlu, İ. H. (2017). Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS). Journal of Istanbul Faculty of Medicine, 80(3), 120-124. https://doi.org/10.18017/iuitfd.332870
AMA Türkyılmaz G, Ertürk E, Saraç Sivrikoz T, Kalelioğlu İH. Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS). İst Tıp Fak Derg. September 2017;80(3):120-124. doi:10.18017/iuitfd.332870
Chicago Türkyılmaz, Gürcan, Emircan Ertürk, Tuğba Saraç Sivrikoz, and İbrahim Halil Kalelioğlu. “Abruptio Placentae After Amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS)”. Journal of Istanbul Faculty of Medicine 80, no. 3 (September 2017): 120-24. https://doi.org/10.18017/iuitfd.332870.
EndNote Türkyılmaz G, Ertürk E, Saraç Sivrikoz T, Kalelioğlu İH (September 1, 2017) Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS). Journal of Istanbul Faculty of Medicine 80 3 120–124.
IEEE G. Türkyılmaz, E. Ertürk, T. Saraç Sivrikoz, and İ. H. Kalelioğlu, “Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS)”, İst Tıp Fak Derg, vol. 80, no. 3, pp. 120–124, 2017, doi: 10.18017/iuitfd.332870.
ISNAD Türkyılmaz, Gürcan et al. “Abruptio Placentae After Amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS)”. Journal of Istanbul Faculty of Medicine 80/3 (September 2017), 120-124. https://doi.org/10.18017/iuitfd.332870.
JAMA Türkyılmaz G, Ertürk E, Saraç Sivrikoz T, Kalelioğlu İH. Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS). İst Tıp Fak Derg. 2017;80:120–124.
MLA Türkyılmaz, Gürcan et al. “Abruptio Placentae After Amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS)”. Journal of Istanbul Faculty of Medicine, vol. 80, no. 3, 2017, pp. 120-4, doi:10.18017/iuitfd.332870.
Vancouver Türkyılmaz G, Ertürk E, Saraç Sivrikoz T, Kalelioğlu İH. Abruptio placentae after amnioreduction in Twin-to-Twin Transfusion Syndrome (TTTS). İst Tıp Fak Derg. 2017;80(3):120-4.

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