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twin to twin transfusion syndromeFrom: JACOB J BARIE MD (jbarie@warwick.net)Fri Nov 28 23:03:18 1997
I found monozyg. diamniot. male twins in my own daughter at 6 weeks...slight discordancy noted at 16 weeks..confirmed at 19wk 4d..with 20% diff in abd. circ.;29% diff. in EFW ;AFI was 25 in big twin..smaller twin was ? oligo,but not quite stuck.Diagnostic amnio at 16 wks showed no other abn...1400 cc of amniotic fluid was removedfrom the big sac at 20wks 2d. I spoke to various experts in TTTS who do not uniformly agree on the best time to start therap. amniocent. One expert felt that it was safer to wait until the oligo was better established.Moreover,there seems to be differences in opinion regarding prognosis....is survival as high as 80% with amniocent?...does fetoscopic laser ablation really make sense if the critical vessels are deep to the placental surface..how can you recognize a critical "steal" anyway? Does anyone out there have any insights with regard to my daughters prognosis under the above cicumstances? Does any one think laser offers more hope? So far the literature seems to favor amniocent. even though it only removes a sympton & doesn't change the vasc. pathology.I'm desparately waiting for some words of wisdom.
-- Jacob J Barie MD...jbarie@warwick.net
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