Location
Moultrie, GA
Start Date
8-5-2024 1:00 PM
End Date
8-5-2024 4:00 PM
Description
Twin-to-Twin Transfusion Syndrome (TTTS) affects 5-15% of all identical twins, which accounts for approximately 6,000 babies a year. TTTS occurs in monochorionic twins (two fetuses sharing one placenta) when an abnormal vascular connection is formed between the two fetuses. This connection then causes one twin to have an excess of amniotic fluid (polyhydramnios). At the same time, the other is deficient (oligohydramnios or anhydramnios), potentially leading to signs of hypovolemia in the donor and hypervolemia in the recipient. If not identified and managed, TTS has an overall mortality rate between 50 and 90%, depending on the severity of the case. All pregnancies with twin gestations are considered at risk for TTTS, primarily if conception occurred utilizing assisted reproductive technology. Morbidity and mortality rates are lowest if the diagnosis is made by first-trimester ultrasound. Diagnosis most commonly occurs between 16 and 26 weeks of gestation, with definitive diagnosis by ultrasound in which the amniotic fluid index and Doppler studies can be monitored closely. The current mainstay intervention is fetoscopic laser ablation in which vascular anastomoses are ligated, preventing fluid transmission between fetuses, and amnioreduction can be done for the recipient twin. Current alternative management strategies include septostomy, amnioreduction, selective fetal termination, or pregnancy termination. The most common complication of fetoscopic laser ablation is preterm labor, which could lead to many severe complications in which the health of the infants is at risk.
This retrospective case report demonstrates the management of a patient with monochorionic diamniotic twin gestations with severe polyhydramnios and anhydramnios due to twin-to-twin transfusion syndrome in a rural healthcare system. The patient presented around 20 weeks gestation for a routine ultrasound in this case. It was then discovered that she had a severe case of twin-to-twin transfusion syndrome. Days later, she presented to labor and delivery with leakage of amniotic fluid. Several high-risk pregnancy specialists were consulted, and eventually, a tertiary healthcare center accepted her transfer for fetoscopic laser ablation. The surgery was successful, and the patient was followed very closely by multiple specialists in the field of obstetrics and gynecology. After approximately 4-5 weeks, the patient experienced a placental abruption and a cesarean section was successfully completed. Despite being delivered at 26 weeks, both babies survived and are healthy, per the patient’s report.
Embargo Period
7-1-2024
Included in
Management of twin-to-twin transfusion syndrome in a rural hospital setting: a case report
Moultrie, GA
Twin-to-Twin Transfusion Syndrome (TTTS) affects 5-15% of all identical twins, which accounts for approximately 6,000 babies a year. TTTS occurs in monochorionic twins (two fetuses sharing one placenta) when an abnormal vascular connection is formed between the two fetuses. This connection then causes one twin to have an excess of amniotic fluid (polyhydramnios). At the same time, the other is deficient (oligohydramnios or anhydramnios), potentially leading to signs of hypovolemia in the donor and hypervolemia in the recipient. If not identified and managed, TTS has an overall mortality rate between 50 and 90%, depending on the severity of the case. All pregnancies with twin gestations are considered at risk for TTTS, primarily if conception occurred utilizing assisted reproductive technology. Morbidity and mortality rates are lowest if the diagnosis is made by first-trimester ultrasound. Diagnosis most commonly occurs between 16 and 26 weeks of gestation, with definitive diagnosis by ultrasound in which the amniotic fluid index and Doppler studies can be monitored closely. The current mainstay intervention is fetoscopic laser ablation in which vascular anastomoses are ligated, preventing fluid transmission between fetuses, and amnioreduction can be done for the recipient twin. Current alternative management strategies include septostomy, amnioreduction, selective fetal termination, or pregnancy termination. The most common complication of fetoscopic laser ablation is preterm labor, which could lead to many severe complications in which the health of the infants is at risk.
This retrospective case report demonstrates the management of a patient with monochorionic diamniotic twin gestations with severe polyhydramnios and anhydramnios due to twin-to-twin transfusion syndrome in a rural healthcare system. The patient presented around 20 weeks gestation for a routine ultrasound in this case. It was then discovered that she had a severe case of twin-to-twin transfusion syndrome. Days later, she presented to labor and delivery with leakage of amniotic fluid. Several high-risk pregnancy specialists were consulted, and eventually, a tertiary healthcare center accepted her transfer for fetoscopic laser ablation. The surgery was successful, and the patient was followed very closely by multiple specialists in the field of obstetrics and gynecology. After approximately 4-5 weeks, the patient experienced a placental abruption and a cesarean section was successfully completed. Despite being delivered at 26 weeks, both babies survived and are healthy, per the patient’s report.