Limb ischemia is an extremely rare event occuring in monochorionic twin pregnancy complicated by twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). The authors describe a case of TTTS and TAPS treated successfully using amnioreduction and laser ablation. However, severe ischemia of both lower extremities in the recipient twin developed after the fetal treatment. This serious complication was diagnosed on MRI in utero and confirmed postnatally. Elective amputation of the affected limbs was performed. The etiology of the disease remains unclear despite profound clinical and histopathological examinations; although the role of thromboembolism in monochorionic pregnancy seems to be most likely, this unique case of multiple limb ischemia with distinct macroscopic findings has not yet been described.

• Keywords
• Monochorionic pregnancy, Multiple limb ischemia, Twin-to-twin transfusion syndrome,
• MeSH
• Amputation, Surgical methods   MeSH
• Anemia complications   diagnostic imaging   surgery   MeSH
• Lower Extremity blood supply   diagnostic imaging   surgery   MeSH
• Twins, Monozygotic * MeSH
• Fetofetal Transfusion complications   diagnostic imaging   surgery   MeSH
• Ischemia complications   diagnostic imaging   surgery   MeSH
• Humans MeSH
• Infant, Very Low Birth Weight * MeSH
• Polycythemia complications   diagnostic imaging   surgery   MeSH
• Pregnancy MeSH
• Lower Extremity Deformities, Congenital complications   diagnostic imaging   surgery   MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

OBJECTIVES: To monitor fetal anemia during administration of chemotherapy to the fetus's mother. STUDY DESIGN: Between 2007 and 2012 six patients with malignancy diagnosed during pregnancy were included in our prospective study. For evaluation of fetal anemia, peak systolic velocimetry (PSV) of the middle cerebral artery is considered the best method. The patients were repeatedly examined one day before and on the third day after the administration of chemotherapy. At least three measurements were performed and the highest value was used as appropriate. Multiples of the median (MoM) were calculated using the website http://www.perinatology.com/calculators/MCA.htm. When the MoM reached 1.29, moderate anemia was diagnosed. RESULTS: The women's average age was 30 years. The average gestational age at diagnosis was 20.7 weeks of pregnancy. Borderline fetal anemia was detected in only in one patient. After delivery newborns were examined by standard pediatric evaluation and blood count was provided. There was no evidence of any newborn anemia. CONCLUSIONS: Chemotherapy administered during pregnancy is becoming more frequent due to increasing knowledge and data on such cases. Close monitoring of the fetus should be performed in specialized centers. For detection of chemotherapy-induced anemia, PSV measurement should be employed.

• Keywords
• Anemia, Chemotherapy, PSV, Pregnancy, Treatment,
• MeSH
• Anemia chemically induced   diagnostic imaging   physiopathology   MeSH
• Middle Cerebral Artery diagnostic imaging   MeSH
• Adult MeSH
• Gestational Age MeSH
• Blood Cell Count MeSH
• Humans MeSH
• Maternal-Fetal Exchange * MeSH
• Pregnancy Complications, Neoplastic drug therapy   MeSH
• Fetal Diseases chemically induced   diagnostic imaging   physiopathology   MeSH
• Infant, Newborn MeSH
• Pilot Projects MeSH
• Prospective Studies MeSH
• Antineoplastic Agents adverse effects   MeSH
• Systole MeSH
• Pregnancy MeSH
• Ultrasonography, Prenatal MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Antineoplastic Agents MeSH

OBJECTIVE: To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery (MCA-PSV) to predict fetal anemia in pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. DESIGN: A prospective study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Olomouc. METHODS: In 38 pregnancies at risk for fetal anemia due to maternal red-cell alloimmunization MCA-PSV had been assessed and fetal blood sampling for measurement of hemoglobin concentration was obtained subsequently, either by cordocentesis or at delivery. RESULTS: 66 examinations were performed at 19-37 week's gestation. An MCA-PSV >1.5 MoM detected 100% of severely anemic fetuses with a hemoglobin concentration <0.65 MoM that required invasive intervention. In 18 cases a cordocentesis was performed and intrauterine blood transfusion was given alternatively. Remaining fetuses did not require invasive intrauterine intervention and no or mild hemolytic anemia and hyperbilirubinemia were diagnosed after delivery. No false positive case was identified (enregistered). The median maternal age at the term of delivery was 29.1 (range, 19-41) years. CONCLUSION: Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anemia. A Doppler interval of seven days is recommended.

• MeSH
• Anemia diagnostic imaging   therapy   MeSH
• Middle Cerebral Artery diagnostic imaging   physiopathology   MeSH
• Erythroblastosis, Fetal diagnostic imaging   therapy   MeSH
• Blood Transfusion, Intrauterine MeSH
• Humans MeSH
• Fetal Diseases diagnostic imaging   MeSH
• Risk Factors MeSH
• Blood Flow Velocity * MeSH
• Pregnancy MeSH
• Ultrasonography, Doppler * MeSH
• Ultrasonography, Prenatal * MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH