Transfusão feto-fetal - sobrevivente policitémico

Introduction : Twin-twin transfusion syndrome (TTTS) is associated with the death of one or both foetuses, particularly if diagnosed before 28 weeks’ gestation. Sudden deteriorations can occur, leading to death of the cotwin and neurological handicap in the survivor. Case Report : We report a case of polycythemia in the recipient twin of a pregnancy with TTTS. Laser photocoagulation of placental anastomoses was performed successfully at 18 weeks. Follow-up showed resolution of signs of TTTS on ultrasound examination. Caesarean section at 33 weeks due to foetal death of donor twin, the recipient twin demonstrated symptomatic polycythemia (hematocrit 70%). Partial exchange transfusion (PET) was performed twice in the first 12 hours. Normal hematocrit levels were achieved without complication. Perinatal outcome was good. Conclusion : Despite the prognosis improvement after laser photocoagulation of placental anastomoses, perinatal mortality and morbidity remains height. Key-words : Polycythemia, recipient twin, twin-to-twin transfusion Syndrome. RESUMO Introducao : A Sindrome de transfusao feto-fetal (STFF) e uma doenca cardiovascular complexa que afeta gestacoes gemelares monocorionicas. As gestacoes complicadas pela STFF antes das 28 semanas estao associadas a um risco elevado de perda fetal, morte perinatal e sequelas nos sobreviventes. Caso Clinico : Primigesta, gestacao gemelar, monocorionica, biamniotica. Sinais ecograficos de STFF, pelo que realizou ablacao por laser das anastomoses placentarias as 18 semanas. Cesariana as 33 semanas apos diagnostico de morte in utero do segundo gemeo. Recem-nascido com pletora evidente ao nascimento. Iniciou dificuldade respiratoria na primeira hora de vida tendo iniciado ventilacao nao invasiva, apresentando tambem hipoglicemia e trombocitopenia. Necessidade de duas transfusoes permuta parcial nas primeiras 12 horas de vida por hematocrito venoso de 70 %. Ecografias transfontanelares seriadas sem alteracoes.