Approach to Perinatal Autopsies in Multiple Gestations with Difficult Diagnoses

DOI:  https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.6120

Article Sidebar

PDF (Español (España)) HTML (Español (España)) Lector Inteligente (Español (España)) ePub (Español (España))

Published: Oct 5, 2017
Issue: Vol. 15 No. 3 (2017): Ciencias de la Salud
Section Clinical or Experimental Research


Keywords: Diseases among twins conjoined twins teratoma twins monozygotic dizygotic stillbirth

Main Article Content

Authors

Mercedes Olaya Contreras, MD PhD
Departamento de Patología, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio.
Silvia Helena Galvis Navarrete
Pontificia Universidad Javeriana.
Gustavo Adolfo Giraldo Ospina, MD
Pontificia Universidad Javeriana, Instituto de Genética Humana.
Jorge Armando Rojas Martínez, MD
Pontificia Universidad Javeriana, Instituto de Genética Humana.
Jorge Luis Rodríguez Sarmiento, MD
Pontificia Universidad Javeriana, Hospital Universitario San Ignacio.
Jorge Andrés Franco Zuluaga, MD
Universidad Nacional de Colombia.

Abstract

Introduction: During pediatric, genetic, sonographic, or pathological anatomy examination on complicated twin gestational fetuses, questions arise concerning differential diagnosis, especially when cases are associated with malformations, maceration of several months duration, or complex structural duplications. Objective: To propose an algorithm for approaching perinatal autopsy in complicated multiple gestations. Materials and Methods: Descriptive observational study on twin gestations seen in the Hospital Universitario San Ignacio (HUSI) in 2007-2013. We de ned “complicated twin gestation” as one in which an examination of the fetus or fetuses raised one of the following differential diagnoses: macerated fetus, conjoined fetuses, fetus in fetu, acardiac fetus, or congenital teratoma. An anatomopathological study was performed and twins were classified according to the proposed algorithm. Results: Analysis of 59 cases in which at least one fetus required a perinatal autopsy. The leading causes of death were ascending infections and fetal-twin transfusion syndrome. Among complicated multiple gestations, we observed eight fetuses including three acardiac macerated fetuses. We applied the algorithm proposed in this article. Conclusion: Diagnosis in twin pregnancies can sometimes be difficult. We identify the most important aspects of medical records and perinatal autopsy to be considered in reaching a definitive diagnosis; we develop an algorithm to be applied in these circumstances. 

Author Biographies

Mercedes Olaya Contreras, MD PhD, Departamento de Patología, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio.

Departamento de Patología, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio.

 

Silvia Helena Galvis Navarrete, Pontificia Universidad Javeriana.

Pontificia Universidad Javeriana.

Gustavo Adolfo Giraldo Ospina, MD, Pontificia Universidad Javeriana, Instituto de Genética Humana.

Pontificia Universidad Javeriana, Instituto de Genética Humana.

Jorge Armando Rojas Martínez, MD, Pontificia Universidad Javeriana, Instituto de Genética Humana.

Pontificia Universidad Javeriana, Instituto de Genética Humana.

Jorge Luis Rodríguez Sarmiento, MD, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio.

Pontificia Universidad Javeriana, Hospital Universitario San Ignacio.

Jorge Andrés Franco Zuluaga, MD, Universidad Nacional de Colombia.

Universidad Nacional de Colombia.

How to Cite
Olaya Contreras, MD PhD, M., Galvis Navarrete, S. H., Giraldo Ospina, MD, G. A., Rojas Martínez, MD J. A., Rodríguez Sarmiento, MD J. L., & Franco Zuluaga, MD, J. A. (2017). Approach to Perinatal Autopsies in Multiple Gestations with Difficult Diagnoses. Revista Ciencias De La Salud, 15(3), 357–371. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.6120
References

Kaplan C. Normal values for placentas. En: Color atlas of gross placental pathology. 2nd. ed. New York: Springer; 2007. p. 119-22. doi: 10.1007/978-0-387-33843-9

Olaya CM, Hernández J, Rosero Y, Mendoza D. Implicaciones médicas y legales de la certi cación de “nacido vivo” en Colombia. Rev Colomb Obs Ginecol. 2011;62(3):244–9.

Olaya CM, Salcedo J, Salazar A, Silva J, Bernal J. Anatomical pathology of the umbilical cord and its maternal and fetal clinical associations in 434 newborns. Pediatr Dev Pathol. 2016;(In press).

Fletcher G, Zach T. Multiple Births Workup [internet]. 2015 [citado 2016 jun] Disponible en: http://emedicine.medscape.com/article/977234-overview?src=refgatesrc1

Baergen R. Infectious diseases. En: Manual of and Kaufmann’s pathology of the human placenta. New York: 2005; Springer-Verlag. p. 279–318. doi: 10.1007/b138589

Blackburn W. Umbilical cord. En: Human Malformation and related anomalies. First. Nueva York: 2006; Oxford University Press. p. 1413-95. doi: 10.1093/med/9780199386031.001.0001

Tantbirojn P, Saleemuddin A, Sirois K, Crum CP, Boyd TK, Tworoger S, et al. Gross abnormalities of the umbilical cord: Related placental histology and clinical significance. Placenta. 2009;30(12):1083-8.

Collins JH, Collins CL CC. Silent risk - Issues about the human umbilical cord [internet]. 2011 [citado 2016 jun]. Disponible en: http://www.preginst.com/pucp.html

Horn LC, Langner A, Stiehl P, Wittekind C, Faber R. Identi cation of the causes of intrauterine death during 310 consecutive autopsies. Eur J Obstet Gynecol Reprod Biol. 2004;113(2):134-8. doi: 10.1016/S0301-2115(03)00371-3

Stefos T, Sotiriadis A, Vasilios D, Tsirkas P, Korkontzelos I, Avgoustatos Fetal. Umbilical cord length and parity—the Greek experience. Eur J Obstet Gynecol Reprod Biol. 2003;107(1):41-4. doi:10.1016/S0301-2115(02)00307-X

Genest DR, Williams MA, Greene MF. Estimating the time of death instill born fetuses: I. Histologic evaluation of fetal organs; an autopsy study of 150 stillborns. Obstet Gynecol. 1992;80(4):575-84.

Genest DR. Estimating the time of death instill born fetuses: II. Histologice valuation of the placenta; a study of 71 stillborns. Obstet Gynecol. 1992;80(4):585-92. doi: 10.1097/01.paf.0000257416.68211.20

Jacques SM, Qureshi F, Johnson A, Alkatib AA, Kmak DC. Estimation of time of fetal death in the second trimester by placental histopathological examination. Pediatr Dev Pathol. 2003;6(3):226-32.

doi: 10.1007/s10024-003-8089-9

Marchetti D, Belviso M, Marino M, Gaudio R. Evaluation of the placenta in a stillborn fetus to estimate the time of death. Am J Forensic Med Pathol. 2007;28(1):38-43. doi: 10.1097/01.paf.0000257416.68211.20

Bendon RW, Keeling JW, Khon TY. Pathology of Twinning. En: Fetal and Neonatal Pathology. 2nd. ed. London: 2007; Springer. p. 224-39.

Genest DR, Singer DB. Estimating the time of death in stillborn fetuses: III. External fetal examination; a study of 86 stillborns. Obstet Gynecol. 1992;80(4):593-600. doi: 10.1007/978-3-319-19207-9.

Wainwright HC. My approach to performing a perinatal or neonatal autopsy. J Clin Pathol. 2006;59(7):673-80. doi: 10.1136/jcp.2005.034504

Goldman GA, Dicker D, Feldberg D, Ashkenazi J, Yeshaya A, Goldman JA. The vanishing fetus. A report of 17 cases of triplets and quadruplets. J Perinat Med. 1989;17(2):157-62. doi: 10.1515/jpme.1989.17.2.157

Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, et al. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health

Organization (who) revised glossary of art terminology, 2009. Fertil Steril. 2009;92(5):1520–4.

Roca AM, Griabal GM, Nogues TF, Oncins TR, Aragon SM. Vanishing twiny feto papiráceo en el segundo trimestre de la gestación. Prog Obs Ginecol. 2009;52(2):118-23. doi: 10.1016/S0304-5013(09)70346-2

Luna G, Barragán GCM. Feto compreso y feto pairáceo. Diferencias clínicas, tres casos. Ginecol Obstet Mex. 2011;79(5):313-8.

Filly RA, Goldstein RB, Callen PW. Monochorionic twinning: sonographic assessment. AJR Am J Roentgenol. 1990;154(3):459-69. doi: /pdf/10.2214/ajr.154.3.2106205

Taner MZ, Kurdoglu M, Taskiran C, Kurdoglu Z, Himmetoglu O, Balci S. Early prenatal diagnosis of conjoined twins at 7 weeks and 6 days gestation with two-dimensional Doppler ultrasound: a case report. Cases J. 2009;2:8330. doi: 10.4076/1757-1626-2-8330

Rios LTM, Araujo Júnior E, Nardozza LMM, Nacaratto DC, Moron AF, Martins M da G. Prenatal diagnosis and postnatal findings of cephalothoracopagus janiceps disymmetros: A case report. Case Rep Med. 2012;2012:273-526. doi: 10.1155/2012/273526

Hähnel S, Schramm P, Hassfeld S, Steiner HH, Seitz A. Craniofacial duplication (diprosopus): ct, MR imaging, and MR angiography findings case report. Radiology. 2003;226(1):210-3. doi:10.1148/radiol.2261011754

Amr SS, Hammouri MF. Craniofacial duplication (diprosopus): Report of a case with a review of the literature. Eur J Obstet Gynecol Reprod Biol. 1995;58(1):77-80. doi: 10.1016/0028-2243(94)01937-3

Olaya CM, Rojas J, Franco JA. Craniofacial duplication: one of the rarest malformations in humans. apm. 2014;20(1):45-8.

Spencer R. Parasitic conjoined twins: External, internal (fetuses in fetu and teratomas), and detached (acardiacs). Clin Anat. 2001;14(6):428-44. doi: 10.1002/ca.1079

Hart I, Gilbert-Barness E. Tumors. En: Potter’s Pathology of the fetus, infant and child. 2nd. ed. Philadelphia: 2007; Mosby Elsevier. p. 1677-85. doi: 10.1097/PAP.0b013e318166137a

Lakhoo K. Neonatal surgical conditions. Early Hum Dev. 2014;90(12):933. doi: 10.1016/j.earlhum- dev.2014.09.015

Olaya CM, Gamboa J, Espinosa L, Uribe AM. Teratomas congénitos en el Hospital Universitario San Ignacio. Univ Med. 2011;52:442-51.

Isaacs H Jr, Gilbert-Barness E. Germcell tumors. En: Potter’s Pathology of the fetus, infant and child. 2nd. ed. Philadelphia: 2007; Mosby Eslsevier. p. 1690-7. doi: 10.1097/PAP.0b013e318166137a

Gordillo G, Olaya M. Teratoma congénito de origen intracraneano. Colomb Cancerol. 2009;13:44-8. doi:10.1016/S0123-9015(09)70151-9

Takayasu H, Kitano Y, Kuroda T, Morikawa N, Tanaka H, Fujino A, et al. Successful management of a large fetal mediastinal teratoma complicated by hydrops fetalis. J Pediatr Surg. 2010;45(12):e21-4. doi: 10.1016/j.jpedsurg.2010.08.055

Swamy R, Embleton N, Hale J. Sacrococcygeal teratoma over two decades: Birth prevalence, prenatal diagnosis and clinical outcomes. Prenat Diagn. 2008;28(11):1048-51. doi: 10.1002/pd.2122.

Heerema-McKenney A, Harrison MR, Bratton B, Farrell J, Zaloudek C. Congenital teratoma: aclini-copathologic study of 22 fetal and neonatal tumors. Am J Surg Pathol. 2005;29(1):29-38.

Chih-Ping C. Acardiac twinning (twin reversed arterial perfusion sequence): A review of prenatal management. Taiw J Obs Gynecol. 2005;44(2):105-15.

Sepúlveda W, Wong AE, Pons A, Gutiérrez J, Corral E. Secuencia de perfusión arterial reversa (gemelo acárdico): evaluación prenatal y tratamiento. Rev Chil Ultrason. 2005;8:118-30.

Cruz-Hernandez M, Jaramillo-Valencia JL, Mejía-García N, Gutiérrez-Marín JH, Sanín-Blair JE. Acardius acormus: una presentación atípica en el embarazo gemelar. Revisión de la literatura. Rev Colom Obs Ginec. 2009;60:382-6.

Quilez JC, Dehes T, Marqués M, Andia D, Fraca M, López M. Feto acardio en gestación gemelar monocorrial biamniótica. Síndrome de perfusión arterial inversa gemelar. Prog Obs Ginecol. 2011;54(8):436-40. doi:10.1016/j.pog.2011.03.002

Obladen M. From monster to twin reversed arterial perfusion: a history of acardiac twins. J Perinat Med. 2010;38(3):247-53. doi: 10.1515/JPM.2010.043

Hanley LC, Boyd TK, Hecht JL. Acardiac twin presenting as fetus amorphous with an attenuated umbilical cord. Pediatr Dev Pathol. 2007;10(6):487-90. doi: 10.2350/07-02-0222.1

Bharadwaj MK, Mohana Priya N. A rare complication of monochorionic twin pregnancy: Twin-reversed arterial perfusion (trap) sequence. Med J Armed Forces India. 2015;71(Suppl 1): S114-5. doi: 10.1016/j.mja.2013.06.008

Giménez-Scherer JA, Davies BR. Malformations in acardiac twins are consistent with reversed blood flow: liver as a clue to their pathogenesis. Pediatr Dev Pathol. 2003;6(6):520-30. doi:10.1007/s10024- 002-1002-0

Olaya-CM, Castro D. Feto acárdico: la malformación más grave en humanos. Patol Rev Latinoam. 2013;51:46-6.

Das K. Acardiacus anceps. J Obs Gynaecol Br Emp. 1902;4(2):341-55.doi:10.1111/j.1471-0528.1902. tb15905.x

Patankar T, Fatterpekar GM, Prasad S, Maniyar A, Mukherji SK. Fetus in fetu: CT appearance—report of two cases. Radiolog. 2000;214(3):735-7. doi: 10.1148/radiology.214.3.r00mr32735

Machin G, Gilbert-Barness E. Multiple pregnancies and conjoined twins. En: Potter’s Pathology of the fetus, infant and child. 2nd. ed. Philadelphia: 2007; Mosby Elsevier p. 355-99. doi: 10.1097/PA- P.0b013e318166137a

Query Statistics

Downloads

Download data is not yet available.
Publcation metrics

959 539




 

Published articles are solely the authors’ responsibility and do not commit the Editorial Committee nor the Scientific Committee. The copyrights belong to the Revista Ciencias de la Salud, therefore, total or partial reproduction of the published material is forbidden, unless there is a previous authorization.