İkizden ikize transfüzyon sendromunda amniodrenaj sonrası tersine transfüzyon ve alıcı-verici fetus rollerin değişmesi: Olgu sunumu

Reversal of donor-recipient roles in twin to twin transfusion syndrome following serial amniodrainages

Özet

Amaç: Günümüze kadar, ikizden ikize transfüzyon sendromunda (İTS) verici fetusun ölümü yada amniosentez sonrası tersine transfüzyon birkaç olguda bildirilmiştir. Ancak literatürde alıcı-verici fetus rollerinin iki kez değiştiğini bildirilmemiştir. Bu yazıda kliniğimizde gözlenen ve sonlandırılan ve alıcı-verici fetus rollerinin iki kez değiştiği İkizden İkize transfüzyon sendromu olgusu sunulmuştur. Olgular: Perinatoloji kliniğimizde izlenen ve 21 gebelik haftasında ikizden ikize transfüzyon sendromu tanısı konulan monokoryonik diamniotik ikiz gebelik olgusunda seri amniodrenaj sonrası 24. ve 34. gebelik haftalarında drenajı takiben alıcı-verici fetus rollerinin iki kez değiştiği ve transfüzyonun tersine döndüğü gözlendi. Otuzaltıncı gebelik haftasında sağlıklı iki kız bebek doğurtuldu. Sonuç: Bu olgu İkizden İkize transfüzyon sendromunun klinik seyrinin ve alıcı-verici fetus rollerinin değişken olabileceğini ve amniodrenajın transfüzyon dinamiklerini etkilediğini göstermektedir.

Abstract

Objective: Reversal of flow from the surviving recipient back to the original donor after the donor’s death and reversal of donor–recipient roles after therapeutic amniocentesis were reported. To date, alternating (reversal twice) of donor-recipient roles in twin-twin transfusion syndrome has not been reported in the literature. Here we report a case presenting reversal of donor-recipient roles in twin to twin transfusion syndrome. Case: A monochorionic diamniotic twin pregnancy were diagnosed as twin to twin transfusion syndrome at 21 weeks of gestation. Donor-recipient roles reversed twice at 24 and 34 weeks of gestation following serial amniodrainages. The patient delivered two healthy babies at 36 weeks’ gestation. Conclusion: This case shows variable expression of the syndrome and supports that amniodrenage can change the transfusion dynamics. Key words: Twin-twin transfusion syndrome, alternating and reversal of donor-recipient rolesUMMARY REVERSAL OF DONOR - RECIPIENT ROLES IN TWIN TO TWIN TRANSFUSION SYNDROME FOLLOWING SERIAL AMNIODRAINAGES Objective: Reversal of flow from the surviving recipient back to the original donor after the donor’s death and reversal of donor–recipient roles after therapeutic amniocentesis were reported. To date, alternating (reversal twice) of donor-recipient roles in twin-twin transfusion syndrome has not been reported in the literature. Here we report a case presenting reversal of donor-recipient roles in twin to twin transfusion syndrome. Case: A monochorionic diamniotic twin pregnancy were diagnosed as twin to twin transfusion syndrome at 21 weeks of gestation. Donor-recipient roles reversed twice at 24 and 34 weeks of gestation following serial amniodrainages. The patient delivered two healthy babies at 36 weeks’ gestation. Conclusion: This case shows variable expression of the syndrome and supports that amniodrenage can change the transfusion dynamics.