| Timely diagnosis of twin-to-twin transfusion syndrome in monochorionic twin pregnancies by biweekly sonography combined with patient instruction to report onset of symptoms. | |
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MedLine Citation:
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PMID: 16969785 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To assess the value of serial ultrasound examinations together with patient instructions to report the onset of symptoms in achieving timely detection of twin-to-twin transfusion syndrome (TTTS) in a cohort of monochorionic diamniotic twin pregnancies, and to evaluate sonographic TTTS predictors. METHODS: Timely detection of TTTS was defined as diagnosis before severe complications of TTTS occurred, such as preterm prelabor rupture of membranes, very preterm delivery (24-32 weeks of pregnancy), fetal hydrops, or intrauterine fetal death. During a 2-year period, a prospective series of 23 monochorionic twin pregnancies was monitored from the first trimester until delivery. At least every 2 weeks we performed ultrasound and Doppler measurements (nuchal translucency thickness, presence of membrane folding, estimated fetal weight, deepest vertical pocket, bladder filling, and Doppler waveforms of the umbilical artery, ductus venosus and umbilical vein). Measurements of TTTS cases were compared with those of non-TTTS cases matched for gestational age. Furthermore, patients were informed about the symptoms caused by TTTS, and instructed to consult us immediately in case of rapidly increasing abdominal size or premature contractions. RESULTS: In all four TTTS cases, the diagnosis was timely. At the time of diagnosis, one case was at Quintero Stage 1, two at Quintero Stage 2, and one at Quintero Stage 3. Two of the TTTS cases became apparent after the patients' feeling of rapidly increasing girth. The identification of TTTS predictors was successful with respect to one parameter: isolated polyhydramnios in one sac, without oligohydramnios in the other, preceded the ultimate diagnosis of TTTS in two of the four TTTS cases. All other ultrasound measurements of TTTS cases, prior to the diagnosis of TTTS, were within the range of measurements of non-TTTS cases. CONCLUSION: Biweekly ultrasound examinations, with special attention to the amniotic fluid compartments of both fetuses, combined with detailed patient instructions to report the onset of symptoms resulted in timely diagnosis of all TTTS cases and appears to be a safe program for monitoring monochorionic twin pregnancies. |
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Authors:
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M Sueters; J M Middeldorp; E Lopriore; D Oepkes; H H H Kanhai; F P H A Vandenbussche |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 28 ISSN: 0960-7692 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 2006 Oct |
Date Detail:
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Created Date: 2006-10-02 Completed Date: 2007-08-08 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: England |
Other Details:
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Languages: eng Pagination: 659-64 Citation Subset: IM |
Copyright Information:
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Copyright 2006 ISUOG. Published by John Wiley & Sons, Ltd. |
Affiliation:
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Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Female Fetal Diseases / ultrasonography* Fetofetal Transfusion / complications, therapy, ultrasonography* Gestational Age Humans Maternal Age Patient Education as Topic* Pregnancy Prenatal Care / methods Prospective Studies Ultrasonography, Prenatal / methods* |
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