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Inicio Clínica e Investigación en Ginecología y Obstetricia Síndrome de transfusión fetofetal
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Vol. 30. Núm. 2.
Páginas 64-67 (Enero 2003)
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Vol. 30. Núm. 2.
Páginas 64-67 (Enero 2003)
Acceso a texto completo
Síndrome de transfusión fetofetal
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T. Pérez-Reyes, I. Eguiluz,, M.A. Barber, P.A. Doblas, L. Alonso, J.V. Hijano, G.M. Franco, I. Aguilera, I. Cohen, J.M. Larracoechea
Departamento de Obstetricia y Ginecología. Hospital Materno-Infantil. Hospital regional Carlos Haya. Málaga. España.
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Summary

This is a rare syndrome which affects monochorio-nic twin pregnancies due to different vascular placen-tary connections. It gives rise to a deficient perfusion in one of the twins and an increase in perfusion in the other with a mixture of the ciculatory systems. Diagnosis is made by ultrasound, following signs of foetal compromise although the physiopathology is unclear. Foeto-foetal transfusion syndrome is very serious, with high rates of foetal morbimortality. Treatment has still to be defined, amnioreduction being the treatment of choice, although nowadays laser coagulation of placental anastomoses using fetos-copy is becoming more common. There are also possibilities, in the future, of ultrasound treatment of this syndrome.

We describe a couple of cases and make a bibliography review.

Resumen

Éste es un extraño y complicado síndrome,en el cual,en gestaciones gemelares monocoriónicas, se producen diferentes conexiones vasculares placentarias que condicionan una deficiente perfusión de uno de los gemelos,así como un aumento de la misma en el otro,con una mezcla de sangre de los dos sistemas circulatorios. Su diagnóstico es fundamentalmente ecográfico,por los signos de afección fetal,y tiene una fisiopatología aún por aclarar. Es un síndrome de gran gravedad, con alta morbimortalidad fetal. El tratamiento sigue sin estar definido,y es de elección la amniocentesis evacuatoria,aunque la fotocoagulación selectiva con láser mediante fetoscopia tiene cada vez más aceptación. Existen nuevas posibilidades futuras en el tratamiento de este síndrome con ultrasonidos. Describimos dos casos y realizamos una revisión bibliográfica.

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Bibliografía
[1.]
D.W. Skupski.
Twin-twin transfusion syndrome: an update.
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[2.]
R.B. Cincotta, P.H. Gray, G. Phythian, U.M. Rogers, F.Y. Chan.
Long term outcome of Twin-twin transfusion syndrome.
Arch Dis Child Fetal Neonatal Ed, 83 (2000), pp. 171-176
[3.]
K.L. Brackley, M.D. Kilby.
Twin-twin transfusion syndrome.
Hosp Med, 60 (1999), pp. 419-424
[4.]
M.L. Denbow, P. Cox, M. Taylor, D.M. Hammal, N.M. Fisk.
Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome.
Am J Obstet Gynecol, 182 (2000), pp. 417-426
[5.]
D.G. Talberg, R. Barojia, W. Sepulveda, S. Bower, N.M. Fisk.
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Am J Obstet Gynecol, 174 (1996), pp. 589-608
[6.]
D. Mahiou, M. Dommerges, A.L. Delezoide, M. Laceste, Y. Cai, F. Narcy, et al.
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[7.]
R. Barojia, M. Hancock, S. Ward, S.W. D’souza, S.R. Sooranna.
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Pediatr Res, 48 (2000), pp. 821-828
[8.]
M. Hayakawa, M. Oshiro, S. Mimura, Y. Katou, R. Takahashi, H. Nishikawa, et al.
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[9.]
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[10.]
H.A. Zondervan, M.J. Van Gemert, P.J. Nikkels, A. Omtzigt, M. Offringa, J. Deprest, al. et.
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[11.]
M.J. Taylor, M.L. Denbow, K.R. Duncan, T.G. Overton, N.M. Fisk.
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[12.]
N.J. Sobire, A. Souka, H. Skentou, L. Coorts, KH. Early prediction of severe twin-twin transfusion syndrome. Nicolaides.
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[13.]
K. Szaflik, D. Borowski, J. Wilezynski, D. Wyrwas, M. Kozarzewski, P. Hincz, et al.
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[14.]
N. Sehire, M. Taylor, NM. Consequences of in utero deth in pregnancy. Fisk.
Lancet, 356 (2000), pp. 1108-1109
[15.]
Y.C. Seng, V.S. Rajadurai.
Twin-twin transfusion syndrome: five year review.
Arch Dis Child Fetal Neonetal Ed, 83 (2000), pp. 168-170
[16.]
G. Mari, L. Detti, U. Oz, A.Z. Abuhamad.
Long term outcome in Twin-twin transfusion syndrome treated with serial aggresive amnioreduction.
Am J Obstet Gynecol, 183 (2000), pp. 211-217
[17.]
R.A. Quintero, W.L. Morales, M.H. Allen, P.W. Bornick, P.K. Johnson, M. Kruger.
Staging of twin-twin transfusion syndrome.
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[18.]
M.L. Denbow, M.R. Battin, F. Cowan, D. Azzopardi, A.D. Edwards, N.M. Fisk.
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Am J Obstet Gynecol, 178 (1998), pp. 479-483
[19.]
Y.F. Cheung, M.J. Taylor, N.M. Fisk, A.N. Redington, H.M. Gardiner.
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Lancet, 355 (2000), pp. 1157-1158
[20.]
J.E. Dickinson, S.F. Evans.
Obstetric and perinatal outcomes from the Australian and New Zeland twin-twin transfusion syndrome registry.
Am J Obstet Gynecol, 182 (2000), pp. 706-712
[21.]
P.Y. Ling, M.V. Leo, J.F. Rodis, W.A. Campbell.
Amniorreduction in triplet fetofetal transfusion.
Obstet Gynecol, 96 (2000), pp. 843
[22.]
C. Hubinot, P. Bernard, N. Pirot, J. Biard, J. Donnez.
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[23.]
J. Hartung, R. Chaoui, R. Bollmann.
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[24.]
L.R. Pistorius, C.R. Howarth.
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[25.]
M.H. Allen, N.S. Carabelis, P.W. Bornick, R.A. Quintero.
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AORN J, 71:796 (2000), pp. 801-810
[26.]
V.A. Feldstein, G.A. Machin, C.T. Albanese, P. Sandberg, J.A. Farrell, D.L. Farmer, et al.
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Fetal Diagn Ther, 15 (2000), pp. 257-261
[27.]
K. Hecher, W. Diehl, L. Zikulnig, M. Vetter, B.J. Hackeleer.
Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid trimester twin-to-twin transfusion syndrome.
Eur J Obstet Gynecol Reprod Biol, 92 (2000), pp. 135-139
[28.]
R. Milner, T.M. Crombleholme.
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Semin Perinatol, 23 (1999), pp. 474-483
[29.]
M.L. Denbow, I.H. Rivens, I.J. Rowland, M.O. Leach, N.M. Fisk, G.R. Haar.
Preclinical development of noninvasive vascular occlusion with focused ultrasonic surgery for fetal therapy.
Am J Obstet Gynecol, 182 (2000), pp. 387-392
Copyright © 2003. Elsevier España, S.L.. Todos los derechos reservados
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