The twin embolization syndrome (TES) occurs in one twin (or other fetus in a multiple gestation) in utero following the death of another fetus.


Clinical features - all of the following:

(1) monozygotic twins or other multiple gestation

(2) presence of a shared circulation (twin-twin transfusion syndrome)

(3) death of one twin in utero with release of tissue thromboplastin into blood

(4) thromboemboli in the other twin with

(4a) defects of the central nervous system

(4b) small bowel atresia or other gastrointestinal disorders

(4c) renal cortical necrosis or other genitourinary disorders

(4d) a chance of intrauterine demise


Early recognition may allow for an intervention that can preserve the surviving fetus.


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