Diagnostic ultrasound ( PDFDrive )

1126 PART IV Obstetric and Fetal Sonography
A
B
FIG. 32.12 Early Twin-Twin Transfusion Syndrome; Stage I. (A) and (B) Monochorionic twins at 16 weeks’ gestational age. A discrepancy
in abdominal diameters is apparent. The smaller twin on the maternal left (L) has much less amniotic luid than the larger twin on the maternal
right (R). The very thin separating amnion is visible between the twins (arrowhead). See also Video 32.7.
A
B
FIG. 32.13 Twin-Twin Transfusion; Stuck Twin. (A) and (B) Monochorionic twins at 16 weeks’ gestational age. One twin (O) is “stuck” to
the anterior uterine wall as a result of severe oligohydramnios. Its twin (P) is far posterior, freely moving in a large amount of amniotic luid. The
membrane (arrowhead) is barely visible surrounding a tiny amount of echogenic amniotic luid between the legs of the “stuck” twin.
polyhydramnios (Fig. 32.13). In addition to luid discrepancies,
indings can include growth discordance (>20% diference in
estimated fetal weight, with the donor smaller than the recipient),
growth restriction of the donor, and cardiomegaly caused by
volume overload in the recipient. 80 Untreated, approximately
three-quarters of stage I fetuses remain stable or regress, whereas
the perinatal loss rate for stage III or higher is between 70% and
100%. 52 A treatment option for TTTS is fetoscopic laser surgery
performed at specialized centers worldwide; a less invasive
alternative is serial amniocentesis to equalize luid volumes and
decrease the risk of preterm labor. 82,83
Twin Anemia Polycythemia Sequence
he twin anemia polycythemia sequence (TAPS) was irst
described in 2007 by Lopriore et al., who presented two cases
of presumed TTTS without associated amniotic luid