ABRUPTIO PLACENTAE AFTER AMNIOREDUCTION IN TWIN-TO-TWIN TRANSFUSION SYNDROME (TTTS)

Abstract

Twin-to-twin transfusion syndrome (TTTS) is a unique complication of monochorionic twin pregnancies. TTTS is the well-known cause of perinatal mortality and morbidity in monochorionic pregnancies. Fetoscopic laser ablation is the optimal treatment but in some selected cases amniodrainage can be performed. We hereby report a case of placental abruption after amniodrainage in a monochorionic diamniotic twin pregnancy. A 37-year-old gravida 4 para 3 who was 26 weeks pregnant was referred to our clinic for monochorionic diamniotic twin pregnancy. Ultrasonographic examination revealed that one of the twins has polyhydramnios while the other has oligohydramnios. The bladder of each twin was visualized separately. We suspected Quintero stage 1 TTTS. Amniodrainage is the appropriate treatment of choice at this time of pregnancy. We performed amniodrainage with a vacuum aspiration device. During the procedure, there was no bleeding in amniotic fluid and cardiac activity of both the twins was visualized. After 15 minutes, profused vaginal bleeding and uterine contractions started and was diagnosed with abruptio placentae and an emergency cesarean section was done. In monochorionic twin pregnancies complicated by TTTS, amniodrainage can be performed in selected cases. This procedure has some rare complications such as abruptio placentae, preterm delivery, and preterm rupture of membranes. These complications are not due to the amount and speed of draining the amniotic fluid but some randomized controlled studies are needed in this aspect.