Acute and chronic fetal anemia as a result of fetomaternal. Fetofetal transfusion, more commonly known as twin to twin transfusion syndrome ttts, is a very serious prenatal complication. The intrauterine feto fetal transfusion, sometimes called the human intrauterine parabiotic syndrome because of its similarity to the experimental vascular connection in animals, is a rarely recognized phenomenon. Fetofetal transfusion synonyms, fetofetal transfusion. This is a highly specialised area of medical practice requiring close collaboration between experts in. A rise in fetal wholeblood viscosity during transfusion can be minimized by restricting the posttransfusion fetal hematocrit to approximately 5055%. A 30yearold woman presented with mild adbominal discomfort and decreased fetal movements in the 34th week of her third pregnancy. Bcsh fetomaternal haemorrhage 2009 amended september.
Synonyms for fetofetal transfusion in free thesaurus. It may be helpful to estimate fmh by ae in d positive women who have had an intrauterine death or stillbirth particularly if the cause of death is unknown or fetal haemorrhage is suspected samadi 1999. Twinning and higherorder multiplegestation pregnancies have become relatively frequent in the current era of assisted reproductive techniques. Sinusoidal fetal heart rate pattern due to massive feto. Definition transfusion is the process of transferring whole blood or blood components from one person donor to another recipient. Twintotwin transfusion syndrome ttts, also known as fetofetal transfusion syndrome ffts, twin oligohydramniospolyhydramnios sequence tops and stuck twin syndrome is a complication of disproportionate blood supply, resulting in high morbidity and mortality. Doppler ultrasound velocimetry for timing the second intrauterine transfusion in fetuses with anemia from red cell alloimmunization. In feto maternal alloimmune thrombocytopenia fmait, severe hemorrhage, particularly intracranial haemorrhage ich, may occur before delivery. Fetofetal transfusion definition of fetofetal transfusion. The average volume of fetal blood in the maternal circulation following delivery is less than 1 ml in 96% of women. Management strategies to prevent ich in highrisk pregnancies include maternal administration of intravenous ig with or. Fetal intraperitoneal transfusion for the management of very.
Transient fetal bradycardia during transfusion is the most common complication, occurring in 8% of procedures. Small amount a case report lingling long a, jie yan, b, qiyan li a, ziqi zhou, haixiao deng, chudong wang, ying zoua, and jifeng caia,b adepartment of forensic science, school of basic medical science, central south university, changsha, china. Intrauterine fetal transfusion of red cells uptodate. It takes place in normal pregnancies as well as when there are obstetric or trauma related complications to pregnancy normally the maternal circulation and the fetal circulation are kept from direct contact with each other, with gas and nutrient exchange taking place across a membrane in the placenta. The most common indications for intrauterine transfusion iut are red cells for prevention and treatment of fetal anaemia due to haemolytic disease of the fetus and newborn hdfn or parvovirus infection and platelets for neonatal alloimmune thrombocytopenia nait. Antenatal management of severe fetomaternal alloimmune. Fetomaternal hemorrhage represents a transfer of fetal blood to the maternal circulation. The diagnosis is made at the birth of monozygotic twins by observing unequal blood. Information on feto fetal transfusion syndrome ffts in higherorder multifetal gestation is limited. On april 19, 1961, cholelithotomy and cholecystostomy wereperformed. Twintwin transfusion syndrome ttts is a rare, serious condition that can occur in pregnancies when identical twins share a placenta. Fetal monitoring revealed a sinusoidal heart rate pattern, and abdominal delivery was promptly performed, with the newborn having a hematocrit of 7% due to massive feto maternal transfusion. In fetomaternal alloimmune thrombocytopenia fmait, severe hemorrhage, particularly intracranial haemorrhage ich, may occur before delivery.
Markedly dilated venous collaterals encountered by the surgeon in the region of the porta hepatis. Consider testing for fetomaternal transfusion by kleihauerbetke or flow cytometry if. Fetofetal transfusion syndrome europe pmc article europe pmc. Fetal triplet transfusion syndrome ffftts michael entezami md. Fetal programming medicine starts before birth eduard gratacos. Suggestions have been made that women of child bearing age or young girls should eritroblastosis fetal be given a transfusion with rhcpositive blood or kell 1 positive blood to avoid possible sensitization, but this would strain the. In contrast to fetofetal transfusion syndrome investigated postnatally, a difference in haemoglobin concentration of 50 gl or more in utero was found in only one pregnancy, which was near term, although all had fetal erythroblastaemia and a difference in. Small amount fetal blood is commonly found in maternal circulation. Target fetal hematocrits at the conclusion of iut vary among treatment centers. The following keywords were used in the basic search strategy.
Intrauterine fetal death in triplet gestation caused by feto. If your twins have ttts, one baby will receive too much blood and. Twintwin transfusion syndrome ttts cincinnati fetal. Fetomaternal transfusion as a cause of severe fetal anemia. This is a highly specialised area of medical practice. Treatment for ttts depends on the severity of the condition and the current stage of your pregnancy. Because twintotwin transfusion syndrome ttts is a progressive disorder, early treatment may prevent complications, including preterm labor and premature rupture of membranes due to excessive fluid polyhydramnios.
Fetal distress can occur after cord accidents rupture. The current trend is to transfuse blood components. Vascular interconnections are present in nearly all monochorionic twin placentae, yet hemodynamically significant arteriovenous anastomoses resulting in the fetofetal transfusion syndrome occur in only 5%18% of these. Media in category twin totwin transfusion syndrome the following 2 files are in this category, out of 2 total. Ultrasound screening for feto fetal transfusion syndrome twin and triplet pregnancy. May 09, 2016 this feature is not available right now. Nine fetuses underwent blood sampling to aid diagnosis and assessment of fetal wellbeing. There were another 8 pairs of stillborn twin fetuses with vascular communications and in these chronic fetofetal transfusion syndrome might have resulted in intrauterine death. Twin to twin transfusion syndrome fetofetal transfusion. Rh incompatibility the mother and baby have a different type of blood, and mothers antibodies to fetal blood cells lyse destroy fetal blood cells. The incidence of fetomaternal transfusion increases with advancing gestation.
Fetalmaternal haemorrhage is the loss of fetal blood cells into the maternal circulation. Postnatal transient renal insufficiency in the fetofetal. It can affect monochorionic multiples, that is, multiple pregnancies where two or more fetuses share a chorion and hence a single. We report outcomes of 10 triplet pregnancies treated by fetoscopic laser occlusion of the. Management of fetofetal transfusion syndrome request pdf. Fetal intraperitoneal transfusion for the management of very early spontaneous twin anemiapolycythemia sequence in an obese patient with a whole anterior placenta volume 19 issue 2 cecile guenot, romaine robyr, nicole jastrow, yvan vial, luigi raio, david baud. The intrauterine fetofetal transfusion, sometimes called the human intrauterine parabiotic syndrome because of its similarity to the experimental vascular connection in animals, is a rarely recognized phenomenon.
The article addresses the terminology used to refer to the condition and describes the systematic ultrasound assessment of the condition, including the ultrasound diagnosis, the staging. Fetofetal transfusion article about fetofetal transfusion. Synonyms for feto fetal transfusion in free thesaurus. Intrauterine fetal transfusions in the management of fetal. Fetal d typing on cffdna later extended to k, c, c, e service provided for dwomen with antid 4 iuml or with history of fetalneonatal haemolysis standard of care in england blood and transplant. Fetal intraperitoneal transfusion for the management of. Although the term fetofetal transfusion is a mesh term and it is also medically and grammatically correct, twintwin transfusion syndrome, twintotwin transfusion syndrome and ttts are also widely used in textbooks and medical articles. These risks include transfusion of an incorrect blood component due to errors, such as mistaken patient identity, or unpredictable acute transfusion reactions stainsby et al, 2008. Full text get a printable copy pdf file of the complete article 468k, or. Management strategies to prevent ich in highrisk pregnancies include maternal administration of intravenous ig with or without steroids and fetal platelet transfusions. Intrauterine fetal death in triplet gestation caused by fetofetal transfusion syndrome a case report lingling long a, jie yan, b, qiyan li a, ziqi zhou, haixiao deng, chudong wang, ying zoua, and jifeng caia,b adepartment of forensic science, school of basic medical science, central south university, changsha, china. Full text get a printable copy pdf file of the complete article 468k, or click on a page image below to browse page by page.
Feto fetal transfusion syndrome contributes heavily to high rates of perinatal mortality and morbidity in monochorionic multiple pregnancies. Fetomaternal transfusion definition of fetomaternal. Fetal hydrops and other variables associated with the fetal hematocrit decrease after the first intrauterine transfusion for red cell alloimmunization. Its prenatal management has been controversial for at. Among the elements transfused are packed red blood cells, plasma, platelets, granulocytes, and cryoprecipitate, a plasma protein rich in antihemophilic factor viii.
Guidelines on transfusion for fetuses, neonates and older. One hundred pregnant women were studied during the antenatal and the immediate postpartum periods for the presence of fetal cells in the maternal circulation. The portal vein was thrombosed and was described by the surgeon as feeling like a 1cm rope. Fetofetal transfusion syndrome how is fetofetal transfusion syndrome abbreviated. Although many etiologies have been described, most causes of fetomaternal hemorrhage remain unidentified. Herrera r ginecologia obstetricia medicina materno fetal. As compared to multigravida, a higher proportion of primigravida showed fetal cells in their circulation immediately after delivery, an expression perhaps of a relatively more difficult labour in the primigravida.