*SPECIAL GUEST* - Dr. Michael Bebbington.
This week Dr. Bebbington joins us to talk about the background of twin-twin transfusion syndrome (TTTS) as he covers the following topics:
- Pathophysiology of twin-twin transfusion syndrome (TTTS) ‘Donor’ twin vs. ‘Recipient’ twin
- Types of vessel anastomoses involved in TTTS
- AA – artery to artery
- VV – vein to vein
- AV – artery to vein
- VA – vein to artery
- Pathophysiology of the polyhydramnios and oligohydramnios seen in TTTS
- Assessing Dopplers in-utero using ultrasound and the different fetal vessels Doppler is used on
- Defining the Quintero stages of TTTS (I through V)
- Stage I – “Poly” & “Oli”
- Donor DVP <2.0 cm
- Recipient MVP >8.0 cm
- Stage II – No visible bladder in donor twin
- Stage III – Doppler abnormalities in one or both twins (Stage IIID, IIIR, IIIDR, and ‘Atypical Stage III)
- Absent/reversed end diastolic flow in umbilical artery (UA)
- Absent/reversed ‘a’ wave in ductus venosus (DV)
- Umbilical vein (UV) pulsations
- Stage IV – Hydrops in one or both twins
- Stage V – Demise of one or both twins
- Risk of demise of both fetuses and physiological changes in the surviving twin should one twin die in-utero
- Atypical presentations of TTTS
- Why we use maximum vertical pocket (MVP) or deepest vertical pocket (DVP) to quantify fluid in twins over an amniotic fluid index (AFI)
- Adjuvant TTTS staging systems
- Frequency and rate of occurrence of TTTS in monochorionic pregnancies
- Prognosis, survival and outcomes of TTTS with and without treatment
- Frequency of surveillance for TTTS in monochorionic pregnancies
- How a laser surgery is performed for treatment of TTTS
- Recurrent TTTS and TAPS are complications of incomplete laser surgeries
- Amnioreduction at the end of the procedure to remove extra fluid from the recipient twin amniotic sac
- Pre-operative counseling for the patient and common complications that can occur during or after a laser procedure
- Gestational age at which a laser ablation of placental anastomoses typically occurs
- Follow-up after a laser surgery
- Factors associated with poorer prognosis or poorer survival rates
- Average gestational age of delivery after a laser surgery
- Training programs for learning to do laser surgery for TTTS
- The role of selective reduction in TTTS
- Implications laser surgery can have on future pregnancies for patients
- Risk of developing TTTS in a subsequent pregnancy
