Twin-to-twin transfusion syndrome and limb ischemia: a case report

Abstract

Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies. This condition is associated with high mortality if untreated. Treatment consists of either serial reduction of amniotic fluid or selective laser photocoagulation (SLP). In utero limb ischemia is a known complication of TTTS. An interaction between this condition and SLP has never been established. Here, we describe the first of twins born at 34 weeks’ gestational age, delivered by emergency cesarean section for fetal distress after a pregnancy complicated by severe TTTS. The first twin, the recipient in the TTTS, showed a necrotic right limb, which was amputated above the knee joint on the 23rd day of life. Anatomic-pathological investigation revealed vascular thrombosis. The foot-length was compatible with a gestational age of 16–18 weeks, the time of limb ischemia, which is well before 26 weeks, when SLP was performed. Therefore, we refute that the fetal limb ischemia was a complication of SLP.