OBJECTIVE: Preeclampsia occurs in some twin gestations in association with a placental disorder of one but not both fetuses, thereby placing both at risk. We investigated a novel method of treating preeclampsia in these pregnancies. STUDY DESIGN: Three patients with second trimester preeclampsia linked to a lethal condition in one twin were treated with selective fetocide in an effort to reverse preeclampsia. Two patients presented with twins discordant for severe fetal growth restriction, and 1 patient presented with Ballantyne syndrome and twins discordant for fetal hydrops. RESULTS: Preeclampsia resolved in all 3 patients, allowing continuation of the pregnancy for an additional 9 to 23 weeks before delivery of the remaining fetus. Resolution of preeclampsia occurred in a timeframe consistent with placental involution documented in similar clinical circumstances. CONCLUSION: Selective fetocide may be an option for treating preeclampsia in some twin pregnancies, presumably by causing involution of the pathologic placenta. Delivery is not the only cure for preeclampsia.
OBJECTIVE: Preeclampsia occurs in some twin gestations in association with a placental disorder of one but not both fetuses, thereby placing both at risk. We investigated a novel method of treating preeclampsia in these pregnancies. STUDY DESIGN: Three patients with second trimester preeclampsia linked to a lethal condition in one twin were treated with selective fetocide in an effort to reverse preeclampsia. Two patients presented with twins discordant for severe fetal growth restriction, and 1 patient presented with Ballantyne syndrome and twins discordant for fetal hydrops. RESULTS: Preeclampsia resolved in all 3 patients, allowing continuation of the pregnancy for an additional 9 to 23 weeks before delivery of the remaining fetus. Resolution of preeclampsia occurred in a timeframe consistent with placental involution documented in similar clinical circumstances. CONCLUSION: Selective fetocide may be an option for treating preeclampsia in some twin pregnancies, presumably by causing involution of the pathologic placenta. Delivery is not the only cure for preeclampsia.
Authors: Roberto Romero; Tinnakorn Chaiworapongsa; Offer Erez; Adi L Tarca; Maria Teresa Gervasi; Juan Pedro Kusanovic; Pooja Mittal; Giovanna Ogge; Edi Vaisbuch; Shali Mazaki-Tovi; Zhong Dong; Sun Kwon Kim; Lami Yeo; Sonia S Hassan Journal: J Matern Fetal Neonatal Med Date: 2010-05-12
Authors: Michelle A Hladunewich; Guy Steinberg; S Ananth Karumanchi; Richard J Levine; Sarah Keating; John Kingdom; Johannes Keunen Journal: Nat Rev Nephrol Date: 2009-11 Impact factor: 28.314