-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Acardiac twin From: Peter Wein (p.wein@obstetrics_mercy.unimelb.EDU.AU) Thu Nov 20 15:15:03 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Jeffrey Korotkin: "Re: Enlarged yolk sac" Previous message: Malcolm Griffiths: "Re: Want to go for eight???" In reply to: T-H Bui, Clinical Genetics, Karolinska Hospital: "Re: Acardiac twin" Next in thread: Malcolm Griffiths: "Re: Acardiac twin" <excerpt>ad 1. serial amniodrainage can be done, although you may try septostomy first. ad 2. the TRAP-sequence is associated with at least 50% mortality of the pump twin due to high-output cardiac failure of the normal twin or as a consequence of polyhydramnios and prematurity (Moore et al. Am J Obstet gynecol 1990; 163: 907-12). Thus, amniodrainage is indicated when needed. Fetoscopic cord ligation or coagulation (before 21 wks) is unfortunately not available in your setting. Ultrasound guided cord embolisation is technically not so difficult; however, as both fetuses share the same circulation, the embolisation product may be transfer to the healthy co-twin, and therefore some centres do not perform this anymore. Get in touch with "Holzgreve,Wolfgang" <<Holzgreve@ubaclu.unibas.ch> at the University of Basel about percutanaeous embolisation. Good luck. *************************************** The-Hung Bui, MD -- Associate Head Physician Department of Molecular Medicine Clinical Genetics Unit Karolinska hospital SE-171 76 Stockholm, Sweden phone: +46 8 517 74989 or 517 72472 (secretary) fax: +46 9 32 77 34; email: bui@gen.ks.se or bui@molmed.ki.se </excerpt><<<<<<<< We are a little wary of attempting to embolize the acardiac twin artery because we are worried that leaving the umbilical vein open will still allow flow from the pump twin to the acardiac twin via the umbilical vein, so our current though is to attempt to occlude both vessels by injecting a bulking agent into the Wharton's jelly of the acardiac twin cord at its insertion to occlude both vessels. Another though is that the mortality quoted is a historical figure associated with prematurity. A 29 week fetus born here has >95% survival - is conservative management better? <bigger>Peter Wein </bigger>Senior Lecturer Department of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women Clarendon Street, East Melbourne 3002 Australia Tel: +61 3 9270 2556 Fax: +61 3 9417 5406 Mobile: 0414 691690 Next message: Jeffrey Korotkin: "Re: Enlarged yolk sac" Previous message: Malcolm Griffiths: "Re: Want to go for eight???" In reply to: T-H Bui, Clinical Genetics, Karolinska Hospital: "Re: Acardiac twin" Next in thread: Malcolm Griffiths: "Re: Acardiac twin"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Dec 2 05:22:03 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.