Prenatal diagnosis & Mx of fetal discordant alpha-thalassaem
The following case has been reported in the journal BMJ Case Reports.

A 29-year-old nulliparous woman with a dichorionic diamniotic (DCDA) twin pregnancy was referred to our hospital at 16 weeks’ gestation for prenatal diagnosis. She was diagnosed of Haemoglobin H Constant Spring (Hb H CS; --SEA/αCSα) and her husband of alpha thalassemia-1 trait (--SEA/αα).

Detailed ultrasound showed that left twin had fetal anaemia and early signs of hydrops while the right one was normal. Both twins were female. Amniocentesis in each sac was performed for prenatal diagnosis of thalassemia after a proper counselling with the couple. DNA analysis confirmed that the left fetus was affected with haemoglobin Bart’s hydrops fetalis (--SEA/--SEA) while the right one was alpha thalassemia-1 trait (--SEA/αα). Selective feticide with intracardiac injection of KCl was successfully performed on the hydropic fetus.

Learning points
• Most dichorionic diamniotic (DCDA) twins have different genetic makeup among both fetuses.

• Prenatal diagnosis has to be performed on each fetus separately with careful fetal mapping for later fetal identification.

• Counselling about prenatal diagnosis in DCDA twins has to emphasised on the increased risk of the disease, the invasive procedure and the options for various scenarios including discordant fetal results.

• Selective feticide can be performed by KCl on the fetus correctly identified as affected with Hb Bart’s hydrops fetalis using fetal mapping along with the signs of fetal hydrops on ultrasonography.

• Counselling about selective feticide should include the step of the procedure and complications.

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Dr. S●●●●●v S●●●●●1
Dr. S●●●●●v S●●●●●1 Obstetrics and Gynaecology
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