Fetal Limb Ischaemia in Twin-to-Twin Transfusion Syndrome
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Case Presentation
A 20-year-old multiparous woman (gravida 4, para 3) was referred to a tertiary referral Fetal Medicine Centre at 19 weeks and 3 days with severe twin-to-twin transfusion syndrome (Quintero stage III recipient; III donor) in the UK. The recipient twin had a maximum amniotic pool depth of 10?cm, with intracardiac Doppler evidence of cardiac dysfunction, whilst the donor twin had significant oligohydramnios (maximum pool depth of less than one centimetre), no fetal urine visible in the fetal bladder, and absent end-diastolic velocity on Doppler insonation of the umbilical artery.

After informed consent and counselling, the patient underwent fetoscopic laser ablation. A 2?mm fetoscope was introduced into the recipient twin sac under local anaesthetic and maternal remifentanil sedation. Visualization of the intertwin membrane was achieved and the chorionic plate vasculature was mapped from the recipient and donor cord insertions. Nine arteriovenous anastomoses were visualized and coagulated using a diode laser at power 30 to 40 Watts. The procedure was performed as a sequential selective technique. At the end of the procedure, 2 litres of amniotic fluid was removed by amniodrainage as would be routine in such cases. The procedure was uneventful....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872234/
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