Flow Chart
Chorionicity and Amnionicity
Surveillance of Monochorionic Twins
Unequal Placental Sharing
Twin-Twin Transfusion Syndrome (TTTS)
Staging
Treatment of TTTS
- Fetoscopic laser ablation
–Quintero stage II–IV disease
–Gestational age between 16 weeks 0 day and 26 weeks 0 day of gestation
–Maternal complications such as placental abruption (1%) and intra-abdominal leakage of amniotic fluid (3%)
–Goal: Laser coagulation of the entire vascular equator
- Ultrasound surveillance with MCA Doppler after treatment
–Weekly to assess for recurrent twin-twin transfusion syndrome or the development of twin anemia–polycythemia sequence for 6 weeks
–Then, every 2 weeks as with uncomplicated monochorionic gestation
- Amnioreduction for non-laser candidates (after 26 weeks)
- Selective feticide/Radiofrequency ablation (rarely performed):
–Usually performed after 16 weeks
–Discordant for a major structural abnormality
–One of the twins is moribund
–Severe IUGR of one twin
Twin Reverse Arterial Perfusion Sequence
Twin Anemia Polycythemia Sequence
US Evaluation of Twin Pregnancies Importance of Chorionicity and Amnionicity PPT
RSNA US Evaluation of Twin Pregnancies - Importance of Chorioncity and Amniocity