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Re: TTSFrom: DuBose, Terry (DuboseTerryJ@uams.edu)Mon Mar 21 09:07:39 2005
Dr. Fougner, We once had a case of discordant twins at 6 weeks. I discussed this case as it related to the embryonic heart rates because at 6 LMP weeks they were almost one week different in CRL ages, but the EHR ages were appropriate to each CRL age. See the bottom of: http://www.obgyn.net/us/cotm/0001/ehr2000.htm We followed them throughout gestation and they were delivered spontaneously shortly after the 34th week exam. The twins remained about one week discordant through out gestation, but normal. The path report on the placenta read in part: "... roughly discoid twin placenta which is approximately 25 x 20 x 4 cm and which has attached glistening gray-pink fetal membranes which are fused in the center of the fetal surface to from a thin, translucent partition." There were, "Vascular channels from side 'A' cross the membranous partition onto the fetal surface of side 'B'." It is also noteworthy that the umbilical cords were quite different. Umbilical cord "A" was inserted 5.5 cm from the nearest placental margin and was twice the diameter of cord "B". Cord "B" had a velamentous insertion at the other side of the placenta. The pathology report concluded, "Third trimester diamniotic, monochorionic twin placenta with attached trivascular umbilical cords (two)." "The mother informed us that the smaller twin had some respiratory illness during the first six months, but the larger, twin A, had no problems. Both were doing well at their first birthday." From, and for more complete discussion of this case: DuBose; FETAL SONOGRAPHY; W. B. Saunders 1996, p. 151-154. Note, the mother signed a release of all records pertaining to this pregnancy, including a release for publication. I am not sure this set of twins qualifies as true TTS, though it may be a very mild form. The initial 6 week study came as we were deep in our investigation of the EHR and age. It was particularly interesting that the CRLs and EHRs remained in good predicted relationship as they went over the peak of the EHR curve at 9 weeks. Before 9 weeks the larger twin had the faster heart rate, but after 9 weeks the larger twin had the slower heart rate until the 16th week. Their mother brought the twins by our office every year on their birthday until they were three years old. They twins remained discordant in size until that time, but I have lost contact with the family since I left Texas in 1996. Do you have CRLs and EHRs for your case? I find those very interesting in these very early cases. Let us have followup on what you find. Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Associate Professor & Director Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 DuBoseTerryJ@UAMS.edu http://www.io.com/~dubose/ http://www.uams.edu/chrp/dms/default.asp http://www.obgyn.net/us/panel/panel.htm ---------------------------------------------------------------
--------------------------------------------------------------- -----Original Message----- --------------------------------------------------------------- From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of evsono@pipeline.com Sent: Friday, March 18, 2005 7:49 AM To: Multiple recipients of list ULTRASOUND Subject: TTS What is the earliest gestational age anyone has suspected a case of TTS? art
-- art fougner, md
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