Sage Journals: Discover world-class research

Abstract

Sonography remains the cornerstone in the assessment of twin-to-twin transfusion syndrome in monochorionic twin pregnancies. Twin-to-twin transfusion is a common complication in monochorionic pregnancies, resulting in high perinatal morbidity and mortality rates. A disproportionate placental interconnection leads to hypovolemia and oligohydramnios in the donor twin and hypervolemia and polyhydramnios in the recipient twin. Ruben A. Quintero and his associates developed a staging system with definite sonographic criteria necessary for prognosis and management of these pregnancies. Quintero staging criteria consist of the following: stage 1, bladder of donor twin still visible; stage 2, bladder of donor twin no longer visible, no critical abnormal Doppler; stage 3, critical abnormal Doppler waveforms; stage 4, hydrops; and stage 5, demise of one or both twins.

Keywords

twin-to-twin transfusion syndrome intrauterine growth restriction twin peak sign lambda sign donor twin recipient twin stuck twin oligohydramnios polyhydramnios hydrops sonography

References

Quintero RA , Morales WJ , Allen MH , Bornick PW , Johnson PK , Kruger M. : Staging of twin-to-twin transfusion syndrome. J Perinatol 1999;19:550-555.

Martin JA , Hamilton BE , Sutton PD , et al: Births: final data for 2006. Natl Vital Stat Rep 2009;57(7).

Moise KJ Jr , Johnson A. : There is NO diagnosis of twins. Am J Obstet Gynecol 2010;203(1):1-2.

Finberg HJ : The "twin peak" sign: reliable sign of dichorionic twinning. J Ultrasound Med 1992;11(11):571-577.

Sebire NJ , D’Ercole C. , Carvelho M. , Sepulveda W. , Nicolaides KH : Inter-twin membrane folding in monochorionic pregnancies. Ultrasound Obstet Gynecol 1998;11(5):324-327.

Huber A. , Diehl W. , Bregenzer T. , Hackelöer BJ , Hecher K. : Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstet Gynecol 2006;108(2):333-337.

Fox C. , Kilby MD , Khan KS : Contemporary treatments for twin-twin transfusion syndrome. Obstet Gynecol 2005;105(6): 1469-1477.

Yamamoto M. , Ville Y. : Recent findings on laser treatment of twin-to-twin transfusion syndrome. Curr Opin Obstet Gynecol 2006;18(2):87-92.

Patten RM , Mack LA , Harvey D. , Cyr DR , Pretorius DH : Disparity of amniotic fluid volume and fetal size: problem of the stuck twin-US studies. Radiology 1989;77(1):28-31.

10.

Yalcin FR , Xorfu CG , Lembet A. , Ozden S. , Gokmen O. : The significance of different birth weight difference in discordant twins: a level to standardize? Acta Obstet Gynecol Scand 1998;77(1):28-31.

11.

Chittacharoen A. , Leelapattana P. , Rangsiprakam R. : Prediction of discordant twins by real-time ultrasonography combined with umbilical artery velocimetry. Ultrasound Obstet Gynecol 2000;15(2):118-121.

12.

Sueters M. , Middeldorp JM , Lopriore E. , Oepkes D. , Kanhai HH , Vandenbussche FP : Timely diagnosis of twin-to-twin transfusion syndrome in monochorionic twin pregnancies by biweekly sonography combined with patient instruction to report onset of symptoms. Ultrasound Obstet Gynecol 2006;28(5):659-664.

13.

Linskens IH , Mooij YM , Twisk JW , Kist WJ , Oepkes D. , van Vugt JM : Discordance in nuchal translucency measurements in monochorionic diamniotic twins as predictor of twin-to-twin transfusion syndrome. Twin Res Hum Genet 2009;12(6):605-610.

14.

Answer to diagnostic challenge twin-to-twin transfusion syndrome . J Diagn Med Sonography 1986;2(3):170.

15.

Stinemann JJ , Mougeot M. , Proulx F. : Profiling fetal cardiac function in twin-to-twin transfusion. Ultrasound Obstet Gynecol 2010 ;35(1):19-27.

16.

Taylor MJ , Govender L. , Jolly M. , Wee L. , Fisk NM : Validation of the Quintero staging system for twin-to-twin transfusion syndrome . Obstet Gynecol 2002;100(6): 1257-1265.

A Sonographer’s Perspective: Quintero Staging System for Twin-to-Twin Transfusion Syndrome in Monochorionic Twins

Abstract

Keywords

References