A case report and literature review in twin-twin transfusion syndrome stage III, fetoscopy -guided laser therapy, complicated with ballantyne syndrome and selective IUGR of fetus donor
DOI:
https://doi.org/10.18597/rcog.257Keywords:
Ballantyne syndrome, mirror syndrome, pseudotoxemia, twin-to-twin transfusion syndrome, laser photocoagulationAbstract
Objective: a 21 years old primigravid patient with biamniotic monochorial twin pregnancy and stage III twin-to -twin transfusion syndrome, diagnosed during week 23 of gestation is presented. She was managed with selective, sequential laser photocoagulation of the communicating blood vessels which was complicated by Ballantyne’s syndrome (mirror syndrome) and selective intrauterine growth restriction (IUGR) of the donor fetus. She delivered during week 35 with good perinatal result. The object was to make an updated review of the literature about Ballantyne’s syndrome.
Materials and methods: the PubMed/ MEDLINE, Cochrane databases were searched as well as books on the specialization, related to the term “Ballantyne’s syndrome”, with no restriction regarding publication date.
Conclusion: selective, sequential laser photocoagulation of the communicating blood vessels is the management of choice for twintwin fetus transfusion syndrome. Selective growth restriction of the donor fetus in stage III could be presented in 40% to 70% of cases. Ballantyne’s syndrome could be secondary to placental edema without fetal hydrops; suspecting it, helps to identify which patients could benefit from active management of this pathology.
Author Biographies
Libardo A. Gómez-Castro
Guido Parra
Felipe Vergara
Miguel Parra
Martha Gómez
Rey Cuellar
Rubén Quintero
References
Quintero RA. Twin-twin transfusion syndrome. Clin Perinatol 2003;30:591-600.
Monteagudo A, Roman AS. Ultrasound in multiple gestations: twins and other multifetal pregnancies. Clin Perinatol 2005;32:329-54.
Trevett T, Johnson A. Monochorionic twin pregnancies. Clin Perinatol 2005;32:475-94.
Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higherorder multiple pregnancies. Am J Obstet Gynecol 2004;191:254-8.
Denbow ML, Cox P, Taylor M, Hammal DM, Fisk NM. Placental angioarchitecture in monochorionic twin pregnancies: Relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. Am J Obstet Gynecol 2000;182:417-26.
Umur A, van Gemert MJ, Nikkels PG. Monoamniotic-versus diamniotic - monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome. Am J Obstet Gynecol 2003;189:1325-9.
Bermúdez C, Becerra CH, Bornick PW, Allen MH, Arroyo J, Quintero RA. Placental types and twintwin transfusion syndrome. Am J Obstet Gynecol 2002;187:489-94.
Lewi L, Jani J, Deprest J. Invasive antenatal interventions in complicated multiple pregnancies. Obstet Gynecol Clin North Am 2005;32:105-26.
Quintero RA, Ishii K, Chmait RH, Bornick PW, Allen MH, Kontopoulos EV. Sequential selective laser photocoagulation of communicating vessels in twin twin transfusion syndrome. J Matern Fetal Neonatal Med 2007;20:763-8.
Yamamoto M, El Murr L, Robyr R, Leleu F, Takahashi Y, Ville Y. Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. Am J Obstet Gynecol 2005;193:1110-6.
Robyr R, Lewi L, Salomon LJ, Yamamoto M, Bernard JP, Deprest J, et al. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2006;194:796-803.
Lewi L, Jani J, Cannie M, Robyr R, Ville Y, Hecher K, et al. Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: Is there more than meets the eye? Am J Obstet Gynecol 2006;194:790-5.
Gyamfi C, Stone J, Eddleman KA. Maternal complications of multifetal pregnancy. Clin Perinatol 2005;32:431-42.
Hayashi S, Sago H, Hayashi R, Nakagawa S, Kitagawa M, Miyasaka K. Manifestation of mirror syndrome after fetoscopic laser photocoagulation in severe twin twin transfusion syndrome. Fetal Diagn Ther 2006;21:51-4.
Heyborne KD, Chism DM. Reversal of Ballantyne syndrome by selective second trimester fetal termination. A case report. J Reprod Med 2000;45:360-2.
Heyborne KD, Porreco RP, Selective fetocide reverses preeclampsia in discordant twins. Am J Obstet Gynecol 2004;191:477-80.
Lobato G, Nakamura-Pereira M. Reversion of the Ballantyne syndrome despite fetal hydrops persistence. Fetal Diagn Ther 2008;24:474-7.
Braun T, Brauer M, Fuchs I, Czernik C, Dudenhausen JW, Henrich W, et al. Mirror syndrome: a systematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 2010;27:191-203.
Feldstein VA, Filly RA. Complications of monochorionic twins. Radiol Clin North Am 2003;41:709-27.
Klam SL, Rinfret D, Leduc L. Prediction of growth discordance in twins with the use of abdominal circumference ratios. Am J Obstet Gynecol 2005;192: 247-51.
Chmait RH, Korst LM, Bornick PW, Allen MH, Quintero RA. Fetal growth after laser therapy for Twin-twin transfusion syndrome. Am J Obstet Gynecol 2008;199:47.e1-6.
Kontopoulos EV, Quintero RA, Chmait RH, Bornick PW, Russell Z, Allen MH, Percent absent end-diastolic velocity in the umbilical artery waveform as a predictor of the intrauterine fetal demise of the donor twin after selective laser photocoagulation of communicating vessels in twin twin transfusion syndrome. Ultrasound Obstet Gynecol 2007;30:35-9.
Carbillon L, Oury JF, Guerin JM, Azancot A, Blot P. Clinical biological features of Ballantyne Syndrome and the role of placental hydrops. Obstet Gynecol Surv 1997;52:310-4.
How to Cite
Downloads
Downloads
Published
Issue
Section
License
Copyright (c) 2010 Revista Colombiana de Obstetricia y Ginecología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
