妊娠と小児の健康に関するジャーナル

抽象的な

The Management of a Discordant Toxoplasmosis Infection in a Dizygotic Twin Pregnancy

Huniadi Anca, Sorian Andrea, Zaha Ioana, Antal Liana, Botea Mihai, Bimbo Szuhay Erica and Sandor Mircea

In twin pregnancy the clinical course of congenital toxoplasmosis is concordant for monozygotic twins and is generally discordant between dizygotic ones, where one twin is symptomatic and the other has a subclinical infection [1,2]. It is unknown how the parasite infects the placenta and the fetus, but the severity of the disease is correlated with the extent of placental damage [3]. Case presentation. We present the case of a pregnant patient, known with primary infertility who undergoes an in-vitro fertilization procedure and becomes pregnant with a twin pregnancy, dichorionic, diamniotic. An acute toxoplasmosis infection suspicion occurs in the second trimester and immunoglobulin M (IgM) and immunoglobulin G (IgG) toxoplasmosis are tested and a high value is found. One of the fetuses is affected, shown by ultrasound, magnetic resonance imaging (MRI) and polymerase chain reaction (PCR) from amnion, the other one healthy. The patient opts for feticide, that is legal in Austria, for proven malformations. Conclusions. This case report wants to highlight the fact that the management of twin pregnancy with discordant affliction is a challenge therefore selective feticide is a sensitive issue not accepted in many countries.