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Re: TOPS and Septostomy (was SIDS and subsequent pregnancy) From: T-H Bui, Clinical Genetics, Karolinska Hospital (bui@gen.ks.se) Tue Oct 29 02:38:17 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: David A. Nagey: "Re: OB ER room" Previous message: Ray Kennedy: "Re: OB-GYN-L digest 693" At 16.39 1996-10-28 -0600, Terrence.Jones@ncal.kaiperm.org wrote: > > By now, my guess is only Dr. Bui is still reading! (with the possible >exception of Dr Bergstrom - who will be checking proper paragraph and sentence >struckcha) :) Dr. Bui, along the lines of Terry Dubose's description (per >Dr. Fineberg) {see 9/96 ob-gyn-l}, have you noticed an increase in the >incidence of VCI (velamentous cord insertion) in the donor twin in TOPS (Twin >Olio-Poly Syndrome)? Also, as you mentioned in your Mo-Mo (monochorionic/ >monamnionic) description of morbidity {see Ob-Gyn-l 7/95}, quite a number of >problems arise from cord accidents. I'm not sure if it was Dr. Moise, or Dr. >Copel, who frowned upon fenestration in TOPS as this might convert the >pregnancy to monoamniotic. Yes you were right, but I don't think I was the only reader. Anyhow, I enjoy reading your comments (and noticed that you have paragraphs!). My clinical impression was that marginal cord insertions were more frequent in MZ-twins, but I wasn't sure of VCI. So I checked with the works of Dr Kurt Benirschke in my files, and found that he, of course, had investigated this matter (Robinson LK et al. Am J Obstet Gynecol 1983;146:191-3). They found a disproportionate number of twins with a velamentous insertion suggesting that competition for space at the implantation site leads to both the velamentous insertion of the cord and the associated structural defects which were mostly deformities (oligohydramnios sequence?) of a normally formed part. I like also better your denomination 'TOPS' than TTS without objective evidence (as suggested by Dr Nick Fisk in the literature, a marker such as adult erythocytes should be used). Although, I would admit the high probability of TTS if placental anastomosis are clearly seen with Colour Doppler mapping. As to the risk of converting a diamniotic to a monoamniotic by use of 'septostomy', I don't know the answer since the technique is so new. However, the large experience of genetic amniocentesis world-wide does not suggest it will be a common complication (extrusion of fetal parts into the extracaelomic cavity after amniocentesis). ***************************************************************** The-Hung Bui, M.D. Associate Head Physician -- Department of Clinical Genetics Karolinska Hospital S-171 76 Stockholm, Sweden phone: +46 8 729 4989 or 729 2472 (secretary) fax: +46 8 32 77 34 E-mail: bui@gen.ks.se or The-Hung.Bui@molmed.ki.se ****************************************************************** Next message: David A. Nagey: "Re: OB ER room" Previous message: Ray Kennedy: "Re: OB-GYN-L digest 693"

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