*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 Solomon technique   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

Ver todos los episodios