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TWIN-TWIN

TRANSFUSION

Shannon Barringer, MS, CGC

Department of OB/GYN--UAMS

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Tw in Pre nanc iesMZ TWINS DZ TWINS

Identical 1:250 pregnancies

Fraternal, Non-Identical

One fertilized ovum

splits after

More common

Two separate ovaconception

Increased risk for

Some genetic

component?

many complications Rarely familial

Inc. risks with inc.maternal age.

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Monoz ot ic Tw insRisk for complications dependent

on timing of split

Monochorionic/Monoamniotic

Monchorionic/Diamniotic Dichorionic/Diamniotic

Conjoined Twins

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Monochor ion ic /Monoamniot ic

occurs between Day9-12

Chorion and Amnion

alread formin

Most risky type of twin

gestation

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Monochor ion ic /Diamniot ic

Division occursbetween Day 4-8

post-conception

Chorion begun toform, not amnion

More common than

Mono/Mono

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Sonography Assessm ent o f

Mult ip le Gest a t ion

Is there a membrane separating fetuses? Membrane = Diamniotic

No membrane Monoamniotic

Thick membrane = Di/Di, Thin = Mono/Di

Are there two placentas?

wo = c or on c, ne onoc or on c

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Tw in-Tw in Transfusion

onoc or on c w nsonly (? Mono/Di)

20% of these twins

affected Mortality rates can

approach 80-100%

Worst outcome if24 weeksgestation. Prelim. Data: 65-71% survival of one.

Nonselective FLP---higher death rate for donor, .

Cord Coagulation---In twin with hydrops (usuallyrecipient), usually reserved for imminent demise.

Identification of CV risk indicators: might behelpful in identifying twins who would most likely

.

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Morbid i t in TTTS Loss of one twin increases risk of neurologic

Mesenteric ischemia Bowel necrosis

Skin necrosis

? Limb abnormalities o ycy em a

Hydrocephaly

Preterm birth