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Fetal exsanguination following intrauterine angiographic assessment and selective termination of a hydrocephalic, monozygotic co‐twin
Author(s) -
Donnenfeld Alan E.,
Glazerman Larry R.,
Cutillo Denise M.,
Librizzi Ronald J.,
Weiner Stuart
Publication year - 1989
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.1970090502
Subject(s) - intracardiac injection , medicine , fetus , asystole , anastomosis , bradycardia , angiography , gestation , anesthesia , cardiology , pregnancy , obstetrics , surgery , heart rate , blood pressure , genetics , biology
Selective termination by intracardiac potassium chloride injection was performed in twins discordant for hydrocephaly at 20 weeks' gestation. Because of the potential for vascular anastomoses to exist between the twins, fetal angiography was performed prior to the selective termination procedure. Determination of vascular connections between the fetuses was hindered by fetal bradycardia following intracardiac administration of contrast material. Selective termination was performed without difficulty using intracardiac potassium chloride (KCl) to produce asystole in the twin with hydrocephaly. The unaffected fetus appeared active and had a normal heart rate during and immediately after the procedure. However, both twins were found to have died the following day. Pathologic examination documented several vascular anastomoses between the monochorionic, diamniotic fetuses. A likely cause of death was exsanguination of the normal twin into the abnormal one. This case illustrates the difficulties encountered in selective termination of monozygotic twins and, to our knowledge, represents the first reported use of intrauterine fetal angiography.