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A case of total hysterectomy due to massive maternal bleeding immediately after fetoscopic laser surgery for twin‐twin transfusion syndrome
Author(s) -
Murata Susumu,
Matsumoto Ryo,
Nishimura Hirotake,
Moriya Takuya,
Shimoya Koichiro,
Sugino Norihiro
Publication year - 2021
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14780
Subject(s) - medicine , amniotic fluid embolism , surgery , hysterectomy , amniotic fluid , blood transfusion , laser surgery , obstetrics , pregnancy , fetus , laser , genetics , physics , optics , biology
Twin‐twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionic twin pregnancies and is associated with almost 90% mortality if left untreated. Fetoscopic laser photocoagulation (FLP) is the first‐line therapy for TTTS, and an overall twin survival rate of 75% and at least one survival rate of 90% have been established. We report a case of TTTS complicated with bleeding from the uterine wall by inserting the procedure after FLP. The patient consequently underwent emergency caesarean section. The bleeding was uncontrollable due to atonic bleeding and emergency hysterectomy was performed. To detect the possibility of amniotic fluid embolism (AFE), biochemical blood samples demonstrated that there was no inflow of fetal ingredients in blood vessels of uterine tissue. There was no evidence of damage to any specific vessels by histopathological staining. These findings indicated that the cause of massive bleeding was unlikely to have been AFE. It was concluded that atonic bleeding was likely caused by uncontrollable hemorrhage from an injury lesion where an endoscope had been inserted.