Hydropic Placenta as a First Manifestation of Twin-Twin Transfusion in a Monochorionic Diamniotic Twin Pregnancy

Monochorionic twin pregnancies are at a 10% to 1.5% risk of developing twin-twin transfusion syndrome (TTTS).(1) Monitoring such pregnancies is aimed at evaluating the fetal condition by measuring the amount of amniotic fluid, Doppler parameters, and fetal growth. Twin-twin transfusion syndrome may be staged by the classification of Quintero et al(2) based on sonographic criteria. However, monochorionic twin pregnancies without the characteristic intertwin discordance in amniotic fluid volumes may still be affected by chronic intertwin transfusion, as reported by Lopriore et al.(3) They reported cases with large differences in fetal or neonatal hemoglobin levels in the absence of the twin oligopolyhydramnios sequence and named this unusual condition twin anemia-polycythemia sequence (TAPS). We report a case in which a thickened placenta of one of the cotwins was an early marker for TAPS, before the occurrence of any of the criteria of Quintero et al(2) for TTTS. To our knowledge, a difference in placental thickness and echogenicity as an early sign of TTTS has not been reported before. A MEDLINE search (English language, 1966-2008, search terms "twin to twin transfusion," "placenta," "edema," and "thickened") revealed no other published cases of hydropic placentas in the absence of fetal hydrops in monochorionic twin pregnancies

Hydropic Placenta as a First Manifestation of Twin-Twin Transfusion in a Monochorionic Diamniotic Twin Pregnancy

Monochorionic twin pregnancies are at a 10% to 1.5% risk of developing twin-twin transfusion syndrome (TTTS).(1) Monitoring such pregnancies is aimed at evaluating the fetal condition by measuring the amount of amniotic fluid, Doppler parameters, and fetal growth. Twin-twin transfusion syndrome may be staged by the classification of Quintero et al(2) based on sonographic criteria. However, monochorionic twin pregnancies without the characteristic intertwin discordance in amniotic fluid volumes may still be affected by chronic intertwin transfusion, as reported by Lopriore et al.(3) They reported cases with large differences in fetal or neonatal hemoglobin levels in the absence of the twin oligopolyhydramnios sequence and named this unusual condition twin anemia-polycythemia sequence (TAPS). We report a case in which a thickened placenta of one of the cotwins was an early marker for TAPS, before the occurrence of any of the criteria of Quintero et al(2) for TTTS. To our knowledge, a difference in placental thickness and echogenicity as an early sign of TTTS has not been reported before. A MEDLINE search (English language, 1966-2008, search terms "twin to twin transfusion," "placenta," "edema," and "thickened") revealed no other published cases of hydropic placentas in the absence of fetal hydrops in monochorionic twin pregnancies

Transient non-autoimmune fetal heart block

Objectives: Fetal heart block is a rare and irreversible condition associated with structural heart defects or maternal autoantibodies (SS-A/Ro and SS-B/La) resulting in permanent damage of the atrioventricular (AV) node. This is the first report of 4 cases with a transient fetal heart block in structurally normal hearts without maternal autoantibodies. Methods: A report on 4 patients seen within a 14-year period at one center with fetal heart block without intracardiac abnormalities or maternal autoantibodies. Results: Three patients were referred to our center with a fetal bradycardia (heart rate 70-85 bpm), between 20 and 33 weeks' gestational age, and 1 for a 'triple' test at 16 weeks' gestational age. Echocardiography showed a complete heart block in 2 fetuses, and a second-degree AV block in the other 2. Heart block had completely resolved at all following visits. Postnatal ECG recordings showed normal sinus rhythm in all patients. Echocardiographic evaluation at presentation and follow-up showed normal cardiac anatomy, without signs of hydrops or cardiac decompensation in all patients. All mothers tested negative on SS-A/Ro and SS-B/La autoantibodies. Conclusions: Fetal heart block can occur in the absence of structural heart defects and maternal autoantibodies to SS-A/Ro and SS-B/La. The origin of such heart block is unknown, but its course seems benign: none of the patients ever showed ventricular heart rates <55 bpm, signs of congestive heart failure or fetal hydrops. Heart block resolved spontaneously in all patient

Neurological outcome in isolated congenital heart block and hydrops fetalis

Objective: Isolated fetal heart block ( HB), a condition associated with fetal hydrops, carries a high mortality rate and may result in neurodevelopmental sequelae. To the best of our knowledge, no data exist regarding the long- term outcome of such hydropic fetuses. We reviewed our experience with this condition to determine the neurodevelopmental outcome of prenatally diagnosed cases with isolated HB complicated by hydrops fetalis. Methods: Neurodevelopmental assessment of 5 children presented prenatally with isolated HB associated with hydrops fetalis. Results: During the last 18 years, 10 cases were detected prenatally with isolated HB and hydrops fetalis. 3 of the 10 fetuses died in utero, and 2 died postnatally, due to a dilated cardiomyopathy, at the age of 9 months and 4 years, respectively. Neurodevelopmental studies done on the 5 remaining children were normal. Conclusion: Long- term neurodevelopmental assessments of 5 surviving cases presented prenatally with isolated HB and hydrops fetalis are reassuring. Copyright (C) 2007 S. Karger AG, Basel

Trends in the utilization of invasive prenatal diagnosis in The Netherlands during 2000-2009

Objective To analyze trends in the number and type of invasive procedure, reasons for referral, maternal age and chromosomal abnormalities over a 10-year period and correlate the trends to changes in the national prenatal screening policy. Methods Data from 10 706 invasive prenatal procedures yielding a full karyotype, performed between 2000 and 2009 were extracted from the cytogenetic database in the central region of The Netherlands. Trends were analyzed. Results Over a 10-year period, the number of invasive procedures halved and the percentage of chromosomal abnormalities detected, increased from 5.5 to 9.4%. After 2007, however, 5.7% of karyotypes in women over 36 years were found to be abnormal, versus 18.1% in women below 36 years. In 2009, 71.5% of women over 36 are still referred for invasive prenatal diagnosis on the indication advanced maternal age. Conclusions Changes in prenatal screening policy significantly increased referral after screening and improved the efficacy of invasive prenatal diagnosis. We show the continuing effect of the different policies applied in the past to women below and above the age of 36. To further improve efficacy of invasive prenatal diagnosis, first trimester combination screening should be actively offered to women of all ages. Copyright (C) 2011 John Wiley & Sons, Ltd