Twin-Twin Transfusion Syndrome…Or Is It?

Twin-Twin Transfusion Syndrome…Or Is It?

IMAGE OF THE MONTH Twin-Twin Transfusion Syndrome . . . Or Is It? Jillian Coolen, MD, Michiel Van den Hof, MD Division of Maternal Fetal Medicine, Fa...

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IMAGE OF THE MONTH

Twin-Twin Transfusion Syndrome . . . Or Is It? Jillian Coolen, MD, Michiel Van den Hof, MD Division of Maternal Fetal Medicine, Faculty of Medicine, Dalhousie University, Halifax NS

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iweekly ultrasound surveillance of a monochorionicdiamniotic twin pregnancy showed appropriately grown twins with no evidence of compromise until 29+6 weeks’ gestation, when a minor amniotic fluid discordance was identified. Amniotic fluid volume was normal around fetus 1 but reduced around fetus 2. At follow-up ultrasound four days later, fetus 2 had oligohydramnios (Figure 1) and an absent bladder. Amniotic fluid volume around fetus 1 remained normal (Figure 2), and both twins had normal Doppler interrogation. Rupture of the membranes was ruled out clinically. Fetal surveillance included ultrasonography every two to three days for suspected stage 2 twin-twin transfusion syndrome (TTTS).1 At 32+0 weeks, fetus 1 was tachycardic. Although Doppler studies remained normal for both twins, induction of labour was recommended because of concern regarding cardiac decompensation for the recipient with possible

Figure 1.

stage 2 TTTS. Both twins delivered vaginally without complication and with the same birth weight (1780 grams). Postnatally, fetus 2 was found to have hypoplastic kidneys. He has been on dialysis since the fifth day of life and is awaiting renal transplant. Consent to publish these images has been obtained from the patient. REFERENCE 1. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson RK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol 1999;19(8 Pt1):550–5.

J Obstet Gynaecol Can 2014;36(4):289

Figure 2.

APRIL JOGC AVRIL 2014 l 289