Skip to main content
SpringerLink
Log in

Short Communication: Successful Outcome of Intrathoracic Injection of Autologous Amniotic Fluid in Fetal Reduction: Report of Two Cases

  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Potassium chloride is reported to kill both monochorionic twins after injection into only one. In this study, two women undergoing in vitro fertilization and embryo transfer were pregnant with triplets containing monochorionic twinning, which were detected by ultrasound with the presence of a “twin-peak” sign. Instead of potassium chloride, intrathoracic injection of amniotic fluid was employed to sacrifice one of the monochorionic fetuses in dichorionic triplets. Our aim was to sacrifice one of the monochorionic twins in order to prevent adverse perinatal outcomes and to avoid the harmful effect of potassium chloride on monochorionic cotwins. One twin pregnancy was terminated with preterm premature rupture of membranes at 25 weeks of gestation. In the second one, two healthy babies were delivered by cesarean section at 36 weeks of gestation. The female baby weighed 2100 gm and the male baby 2600 gm, respectively. Intrathoracic injection of amniotic fluid to create a tamponade is an alternative management for fetal reduction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

REFERENCES

  1. Abusheika N, Salha O, Sharma V, Brinsden P: Monozygotic twinning and IVF/ICSI treatment: A report of 11 cases and review of literature. Hum Reprod Update 2000;6:396–403

    Google Scholar 

  2. Dubé J, Dodds L, Armson BA: Does chorionicity or zygos-ity predict adverse perinatal outcomes in twins? Am J Obstet Gynecol 2002;186:579–583

    Google Scholar 

  3. Chasen ST, Al-Kouatly HB, Ballabh P, Skupski DW, Chervenak FA: Outcomes of dichorionic triplet pregnancies. Am J Obstet Gynecol 2002;186:765–767

    Google Scholar 

  4. van Heteren CF, Nijhuis JG, Semmekrot BA, Mulders LG, van den Berg PP: Risk for surviving twin after fetal death of co-twin in twin-twin transfusion syndrome. Obstet Gynecol 1998;92:215–219

    Google Scholar 

  5. Olivennes F, Doumerc S, Senat MV, Audibert FA, Fanchin R, Frydman R: Evidence of early placental vascular anastomosis during selective embryo reduction in monozygotic twins. Fertil Steril 2002;77:183–184

    Google Scholar 

  6. Kurtz AB, Wapner RJ, Mata J, Johnson A, Morgan P: Twin pregnancies: Accuracy of first-trimester abdominal US in pre-dicting chorionicity and amnionicity. Radiology 1992;185:759–762

    Google Scholar 

  7. Monteagudo A, Timor-Tritsch IE, Sharma S: Early and simple determination of chorionic and amniotic type in multifetal ges-tations in the first fourteen weeks by high-frequency transvagi-nal ultrasonography. Am J Obstet Gynecol 1994;170:824–829

    Google Scholar 

  8. Kaufman GE, Malone FD, Harvey-Wilkes KB, Chelmow D, Penzias AS, D'Alton ME: Neonatal morbidity and mortality associated with triplet pregnancy. Obstet Gynecol 1998;91:342–348

    Google Scholar 

  9. Bajoria R, Kingdom J: The case for routine determination of chorionicity and zygosity in multiple pregnancy. Prenat Diagn 1997;17:1207–1225

    Google Scholar 

  10. Evans MI, Berkowitz RL, Wapner RJ, Carpenter RJ, Goldberg JD, Ayoub MA, Horenstein J, Dommergues M, Brambati B, Nicolaides KH, Holzgreve W, Timor-Tritsch IE: Improvement in outcomes of multifetal pregnancy reduction with increased experience. Am J Obstet Gynecol 2001;184:97–103

    Google Scholar 

  11. Sebire NJ, Snijders RJ, Hughes K, Sepulveda W, Nicolaides KH: The hidden mortality of monochorionic twin pregnancy. Br J Obstet Gynaecol 1997;104:1203–1207

    Google Scholar 

  12. Sepulveda W, Sebire NJ, Hughes K, Odibo A, Nicolaides KH: The lambda sign at 10-14 weeks of gestation as a predictor of chorionicity in twin pregnancies. Ultrasound Obstet Gynecol 1996;7:421–423

    Google Scholar 

  13. Baldwin V. J. Anomalous development of twins. In: Pathol-ogy of Multiple Pregnancies. New York, Springer-Verlag, 1994, pp. 169–197

    Google Scholar 

  14. Taylor MJ, Shalev E, Tanawattanacharoen S, Jolly M, Kumar S, Weiner E, Cox PM, Fisk NM: Ultrasound-guided umbilical cord occlusion using bipolar diathermy for Stage III/IV twin-twin transfusion syndrome. Prenat Diagn 2002;22:70–76

    Google Scholar 

  15. Mansour RT, Aboulghar MA, Serour GI, Sattar MA, Kamal A, Amin YM: Multifetal pregnancy reduction: Modification of the technique and analysis of the outcome. Fertil Steril 1999;71:380–384

    Google Scholar 

  16. Ibérico G, Navarro J, Blasco L, Simón C, Pellicer A, Remohí J: Embryo reduction of multifetal pregnancies following as-sisted reproduction treatment: Amodification of the transvagi-nal ultrasound-guided technique. Hum Reprod 2000;15:2228–2233

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chang-Gung Memorial Hospital, Taipei, Taiwan

    Shang-Gwo Horng, Chia-Woei Wang, Hong-Yuan Huang & Yoong-Kuei Soong

Authors
  1. Shang-Gwo Horng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chia-Woei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Yuan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoong-Kuei Soong
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horng, SG., Wang, CW., Huang, HY. et al. Short Communication: Successful Outcome of Intrathoracic Injection of Autologous Amniotic Fluid in Fetal Reduction: Report of Two Cases. J Assist Reprod Genet 21, 343–345 (2004). https://doi.org/10.1023/B:JARG.0000045475.90846.89

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:JARG.0000045475.90846.89

Search

Navigation