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Re: A twin with exomphalos From: T-H Bui, Clinical Genetics, Karolinska Hospital (bui@gen.ks.se) Fri Sep 13 09:39:14 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Derek van Amerongen: "Re: Stopping Service" Previous message: DoctorJoe@aol.com: "Needle embryofetoscopy?" Maybe in reply to: STEWART PRINGLE: "A twin with exomphalos" At 08.51 1996-09-13 -0500, DoctorJoe@aol.com wrote: >I think the prenatal surgical consultation and close observation of the >babies, until a planned C/S delivery, is the way to go. I agree too. In addition there is a real risk of cord entanglement (about 50%) since there is clear evidence of a monoamniotic pregnancy (monozygous twins). Because of the exomphalos one may expect polyhydramnios contributed by the affected twin, thus increasing the risk for cord problems in utero. I think it was Prof Nick Fisk at Queen Charlotte's in London who suggested that one could try to decrease medically the amount of amniotic fluid after viability gestation has been reached in order to lower the fetal movements and the risk for cord entanglement. There is also the risk of TTS (twin transfusion syndrome), therefore I would add careful Doppler imaging for signs of heart failure in the twins after wks 22. Later in this pregnancy there is the question of timing of delivery. If one waits too long, a cord accident may occur. In the other hand, the affected fetus needs to have matured lungs for the surgery and the post operative care in respirator (with increased intra-abdominal pressure). The balance is difficult! Last should fetal reduction be discussed at all in this situation? ***************************************************************** The-Hung Bui, M.D. Associate Head Physician -- Department of Clinical Genetics Karolinska Hospital S-171 76 Stockholm, Sweden phone: +46 8 729 4989 or 729 2472 (secretary) fax: +46 8 32 77 34 E-mail: bui@gen.ks.se or The-Hung.Bui@molmed.ki.se ****************************************************************** Next message: Derek van Amerongen: "Re: Stopping Service" Previous message: DoctorJoe@aol.com: "Needle embryofetoscopy?" Maybe in reply to: STEWART PRINGLE: "A twin with exomphalos"

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