Midtrimester Genetic Amniocentesis of a Twin Gestation Complicated by Immediate Severe Fetal Bradycardia with Subsequent Associated Fetal Anomalies

ABSTRACT

We present an unusual complication of midtrimester genetic amniocentesis of a monochorionic twin gestation in which prolonged fetal bradycardia of 60 to 80 beats per minute sustained over two hours was associated with multiple subsequent fetal anomalies. These included: microcephaly, bilateral closed-lip schizencephaly, duodenal atresia, and complete paresis of the left upper extremity. Etiology of the fetal bradycardia was unclear. Fetal hemorrhage was not visualized despite targeted, continued real-time ultrasonography and was therefore considered an unlikely etiology. Although the bradycardia and associated hypoperfusion could alone explain the fetal outcome, destabilization of hemodynamics of a communicating vessel, resulting in a possible (although unproven) acute twin-twin transfusion induced at the time of amniocentesis due to decreased intra-amniotic pressure in association with a velamentous umbilical cord insertion could have led to this unusual occurrence.

Genetic amniocentesis - complication - acute twin-twin transfusion - velamentous insertion - schizencephaly - duodenal atresia