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Twins twin transfusion syndrome in monochorionic twins


International Journal of Pregnancy & Child Birth
Mohamed W Gawish, AAAl Ibrahim, Sawsan Al Obaidly, Mohamed Ali Mustafa Khalil, Mohamed Ahmed Abdelmoneam Ramadan

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Abstract

Objective: To  report  our  experience  with  the  Monochorionic  Diamniotic  pregnancies  complicated by Twin-Twin Transfusion Syndrome (TTTS) in a large retrospective cohort study.  It  emphasizes  on  the  clinical  prognostic  implication  of  TTTS,  the  importance  of  timely surveillance and intervention in an attempt to prevent the increased fetal/perinatal morbidity and mortality.

Materials  and  methods: This  retrospective  study  was  conducted  at  Women’s  Hospital,  Hamad  Medical  Corporation,  Qatar  (2003-Oct.2014)  including  all  the  Monochorionic  Diamniotic twins who were complicated by TTTS. The data included the maternal biodata, method of conception and maternal complications, ultrasound findings and follow-ups, intervention (if any), delivery gestational age was as well as the birth/miscarriage data, and birth weight. We kept these data anonymously in a password protected Excel sheet and the analysis carried using online statistics tools.

Results: 18 cases of TTTs diagnosed among 206 Monochorionic diamniotic twin (8.7%), The mean gestational age at diagnosis is 23±4 weeks. 39% had an advanced TTTS (stage 3, 4 and 5). Mean maternal age was 29.5±4.9 years, versus 30.2±5.7 years of No-TTTS cases (p-value 0.6). The rate of miscarriage was 28% and IUFD was 27%, the mean diagnosis-IUFD interval was 1.6±1.6 weeks. The mean gestation age at delivery was 27.2±4.6 weeks versus 30.2±5.7 weeks for the Non-TTTS (p-value 0.0001). The mean birth weight for the alive recipients after 24 weeks was 1364±564 grams versus 907.6±289.9 for the donor (p-value 0.04).

Conclusion: Our   research   highlights   the   continuous   devastating   complications of  monochorionic  twins.  It  is  our  duty  as  health  professionals  to  provide  a comprehensive counselling  as  early  as  chorionicity  regarding  these  risks  and  their  implications on  the mother and fetus/neonate.

Keywords

twins twin transfusion, diabetes, birth weight, pregnancies, chorionicity, fetus, hydrops

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