barringer - twin-twin transfusion syndrome pnc2010
TRANSCRIPT
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TWIN-TWIN
TRANSFUSION
Shannon Barringer, MS, CGC
Department of OB/GYN--UAMS
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Tw in Pre nanc iesMZ TWINS DZ TWINS
Identical 1:250 pregnancies
Fraternal, Non-Identical
One fertilized ovum
splits after
More common
Two separate ovaconception
Increased risk for
Some genetic
component?
many complications Rarely familial
Inc. risks with inc.maternal age.
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Monoz ot ic Tw insRisk for complications dependent
on timing of split
Monochorionic/Monoamniotic
Monchorionic/Diamniotic Dichorionic/Diamniotic
Conjoined Twins
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Monochor ion ic /Monoamniot ic
occurs between Day9-12
Chorion and Amnion
alread formin
Most risky type of twin
gestation
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Monochor ion ic /Diamniot ic
Division occursbetween Day 4-8
post-conception
Chorion begun toform, not amnion
More common than
Mono/Mono
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Sonography Assessm ent o f
Mult ip le Gest a t ion
Is there a membrane separating fetuses? Membrane = Diamniotic
No membrane Monoamniotic
Thick membrane = Di/Di, Thin = Mono/Di
Are there two placentas?
wo = c or on c, ne onoc or on c
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Tw in-Tw in Transfusion
onoc or on c w nsonly (? Mono/Di)
20% of these twins
affected Mortality rates can
approach 80-100%
Worst outcome if24 weeksgestation. Prelim. Data: 65-71% survival of one.
Nonselective FLP---higher death rate for donor, .
Cord Coagulation---In twin with hydrops (usuallyrecipient), usually reserved for imminent demise.
Identification of CV risk indicators: might behelpful in identifying twins who would most likely
.
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Morbid i t in TTTS Loss of one twin increases risk of neurologic
Mesenteric ischemia Bowel necrosis
Skin necrosis
? Limb abnormalities o ycy em a
Hydrocephaly
Preterm birth