Case Report: Early Fetoscopic Management of Monochorionic Twin Pregnancy Complicated by Amniotic Band Syndrome and Twin to Twin Transfusion

Abstract

We report a case where discordant amniotic band syndrome was diagnosed in a monochorionic twin pregnancy in the early second trimester of pregnancy. Pregnancy was also complicated by twin-to-twin transfusion syndrome. Therapeutic options were limited because of the severity of the amniotic strings and the twin transfusion syndrome. We offered selective feticide by bipolar coagulation of the umbilical cord of the affected fetus. This was performed successfully and also converted the transfusion syndrome, leading to the term birth of a healthy baby, with an 'aplasia cutis'-like skin lesion on the skull. The differential diagnostic and therapeutic steps in this complex case are discussed, as well as the possible relationship between the skin lesion and the fetoscopic intervention.