The twin brothers "Gong Dou", both lost in the end...

time:2022-11-27 05:07:12source:monlittlebaby.com author:Make one's mouth water
The twin brothers "Gong Dou", both lost in the end...

*For reference only for medical professionals, a "vicious competition" between brothers began in the mother's womb, a "blood case" between brothers caused by twin pregnancy, and ultimately both sides lost. When he got off work, the obstetrician doctor Tian called: twins, 36+4 weeks, a child's umbilical blood flow ratio was significantly increased, considering the fetal distress, emergency cesarean section was needed, please come to the operating room to assist in the rescue. After the first boy was delivered, he cried loudly and weighed 2.90 kg. 2 minutes later, the second child was delivered, also a boy, with soft and pale skin, slow heart rate, weak breathing, immediately given airbags to assist breathing, the child cried, but the complexion was still pale and shortness of breath. He was immediately transferred to the Neonatology Department, and the weight was measured at 2.04 kg. At the same time, the first child was also transferred as a high-risk infant due to premature twin birth. After entering the department, the eldest son has a little shortness of breath, and the general condition is acceptable. However, the second son had difficulty breathing and was pale, and the transcutaneous oxygen saturation was always around 75% after oxygen was given. What's more, the two children were markedly different in appearance: one fat and one thin, one purplish red and one pale. A serious disease flashed through my mind: twin-to-twin transfusion syndromes (TTTs). Immediate blood test prompts: eldest son Hb 230 g/L, second son Hb 51 g/L. One had polycythemia, one had severe anemia, and the difference in hemoglobin between the two children was 180 g/L. The eldest son was excited, irritable, and had low blood sugar, while the second son was hypotensive, pale, and short of breath. The two brothers, one white and one red, have a weight difference of nearly 0.9Kg, and they are both boys. Asked about the obstetric placenta, amniotic fluid, and umbilical cord: monochorionic diamniotic sac, the color of the placenta is different on both sides, one side is purple and the other is pale, there is a neat dividing line in the middle, one side of the umbilical cord is thick and the other side is small, the amount of amniotic fluid of the eldest son Normal, the second son's amniotic fluid volume is low, and the third degree of fecal staining. The basic diagnosis can be confirmed: twin-to-twin transfusion syndrome. At the same time, the eldest son had polycythemia, and the second son had severe anemia and hemorrhagic shock. The placenta is half purple and half pale, the umbilical cord is thick on one side and the umbilical cord is small on the other side. One is the red-faced Guan Gong and the other is the white-faced Cao Cao. Why is there such a big difference? And there is still such a serious disease, especially the second son, who is dying? In fact, this is all the fault of TTTs. Why did the two brothers fight? TTTs are a serious complication in twin pregnancy with extremely high perinatal mortality, with untreated mortality ranging from 70% to 100%. The vast majority of TTTs occur in diamniotic monochorionic twins, and the pathogenesis is closely related to the way of vascular anastomosis between the two fetuses and placentas. Vascular anastomosis can be divided into superficial and deep two. Superficial anastomosis refers to the anastomosis of the larger blood vessels on the fetal surface of the placenta, most of which are direct artery-artery anastomosis, and a few are direct vein-vein anastomosis. Both types of anastomosis are present on the fetal surface of a few monochorionic twin placentas. Source: Shenzhen Municipal Health Commission And the arterial-venous anastomosis between the two fetal circulations in the deep placenta is more important pathologically: the deep anastomosis is located in one or more adjacent placentas to which the two fetuses belong. In a placental lobule, although it has a variety of anastomosis methods through capillaries, and there is no direct arterial and venous anastomosis, its blood flows from one fetus to another. Generally speaking, in these placental lobules, the arterial and venous anastomosis of the two placentas has an equal distribution of blood flow. As a result, the blood flow from fetus A to fetus B in unit time is equivalent to the flow of fetus B to fetus A. blood flow, so the fetus develops at a similar rate. When the distribution of the convection direction of vascular anastomosis is not equal, the blood flow of fetus A to fetus B is more than the blood flow of fetus B to fetus A in unit time, fetus A becomes the blood donor, fetus B becomes the recipient, and the blood The imbalance of TTTs leads to a series of pathological changes, which is the pathological basis of TTTs. Placental vascular anastomosis. Source: Can CCTV find it early? The donor child of TTTs is gradually in hypovolemia and anemia due to the continuous supply of blood to the recipient child. The individual is small and light weight, similar to the intrauterine growth retardation fetus. At the same time, anemia, decreased red blood cells, low hematocrit, and sometimes There may be mild edema. Of course, blood donors also increase the production capacity of red blood cells to adapt to chronic anemia, but due to low blood volume, oliguria and oligohydramnios. The recipients are larger, and their hearts, livers, kidneys, pancreas and adrenal glands are enlarged. The enlargement of the heart is associated with hypervolemia after receiving blood, and the kidney shows enlarged glomeruli with an increased proportion of mature glomeruli. Increased red blood cells in the blood, hematocrit was significantly higher than the blood supply children, there may be hyperbilirubinemia, high blood volume to increase the fetal urine output resulting in polyhydramnios. Prenatal diagnosis 1. Determination of monozygotic twins: TTTs are generally monochorionic twins, so it is an important condition for diagnosis to be determined by B-ultrasound as monochorionic twins. The findings under B-ultrasound were: (1) a single placenta; (2) a fetus of the same sex; (3) a hair-like mediastinum between the fetuses, which was determined to be a monochorionic twin, and a high diagnostic accuracy was obtained. Gender differences can rule out the diagnosis of TTTs. 2. Differences in the amount of amniotic fluid: The presence of polyhydramnios and oligohydramnios is one of the important diagnostic conditions for TTTs. 3. The difference between the umbilical cord and the placenta: The umbilical cord of the recipient is thicker than that of the donor, and sometimes the recipient's umbilical cord is accompanied by a single umbilical artery. Observation of the placenta with color Doppler ultrasonography may help to identify the communicating branches of the placental vessels of TTTs. 4. Differences in the internal organs of the two fetuses: Most recipient infants in TTTs may have cardiac dysfunction and thickening of the ventricular wall, while the left ventricle of the donor infant is shortened, and the cardiac output increases significantly, indicating that the myocardium is in a state of overactivity. , and the comparison of cardiac parameters of the two fetuses, especially the shortening of the left ventricle, may be helpful for diagnosis. Postpartum diagnosis 1. Placenta: The blood donor placenta is pale, edematous, atrophic, with edema and vasoconstriction of the villi, and amniotic nodules on the amniotic membrane due to oligohydramnios. The placenta of the recipient is red and congested. 2. Hemoglobin level: Generally, the difference between the hemoglobin levels of recipients and donors of TTTs is often more than 5 g/dl, or even 27.6 g/dl than 7.8 g/dl, so the difference of 5 g/dl is currently the diagnostic standard. . But there are also reports that the difference is less than 5 g/dl, especially in the second trimester. 3. Weight difference: The standard of weight difference between two fetuses is generally set at 20%. In addition, when the gestational age is small, the weight difference is small, and the weight of individual blood donors is larger than that of recipients. "Blood Case" finally ended. Seeing that the two brothers were in critical condition, the family members were anxious and helpless, especially the second son. Immediate blood transfusion was the primary condition for saving lives. Unfortunately, the blood bank's first blood matching was unsuccessful, and the second blood matching was still unsuccessful. We considered the mother's blood type O, the child's blood type A, and there was hemolytic disease caused by maternal and infant blood group incompatibility. our diagnosis. There was no other way. At the same time as emergency volume expansion and respiratory support for the child, he contacted Baoding Central Blood Station overnight, and urgently called O-type washed red blood cells for blood matching. Finally, the blood match was successful! At 1:00 in the morning, bright red blood slowly flowed into the second son's body. Seeing that the child's heart rate gradually slowed down, the skin color gradually became rosy, and the oxygen parameters gradually decreased, everyone breathed a sigh of relief. After two small blood transfusions, the vital signs of the second son were stable, but the results of the auxiliary examination were not very satisfactory. The child suffered severe organ damage due to the state of chronic hypoxia-ischemia in the uterus, including the heart, liver, and kidneys. various degrees of damage. The eldest son developed obvious jaundice due to increased red blood cells and hemolysis of ABO. The brothers started a "vicious competition" in the mother's womb, and a "blood case" between the brothers caused by the twin pregnancy ended up losing both sides. Therefore, understanding twin-twin transfusion syndrome, early diagnosis, early intervention, and timely treatment are very important! On the fourth day after birth, after a series of comprehensive treatment, the two brothers are in stable condition. We will definitely work hard to let the two children leave the hospital smoothly and grow up healthily! After treatment, the second son's complexion turned rosy, hemoglobin rose to 120 g/L, and vital signs were stable Reference: [1] Fourth Edition of Practical Neonatology Editor in charge of Pediatrics Li Yuelan: Xiang Yu has all the Pediatric Clinical Knowledge Doctor Station App you want to see👇1. Scan the QR code below the code 2. 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