Fetoscopic demonstration of feto-fetal hemorrhage before actual demise of a monochorionic twin, successful antenatal treatment, and narrative review of the literature

Abstract

Feto-fetal hemorrhage (FFH) through placental vascular anastomoses is believed to be responsible for the death or damage of a “second twin” after the demise of a “first twin (co-twin)” in monochorionic twin pregnancies. However, the timing of FFH has been difficult to determine. The resulting anemia in the surviving twin can be suspected by the finding of an elevated middle cerebral artery peak-systolic velocity (MCA-PSV), but this elevation may lag for at least 4 h after the demise of the first twin. Knowledge of the timing of FFH may have important clinical implications, as it may dictate if and when attempts to prevent death or damage to the second twin by delivery or intrauterine fetal transfusion would be warranted. We present a case that supports the notion that FFH occurs before the actual demise of the first twin. A review of the literature was also conducted.

Keywords:

• Monochorionic twins
• fetoscopy
• selective intrauterine growth restriction
• fetal demise
• fetal anemia

Acknowledgments

We would like to thank Dr. Antonio González Ruiz for the kind referral.

Authors contributions

Dr. Kontopoulos and Dr. Quintero participated in the writing and editing of this manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This work was supported by The USFetus Research Organization and The Brianna Marie Foundation.