What is Twin-Twin Transfusion Syndrome? - TTTS - Fetal Surgery & Treatment - CHOP (1 of 8)


Uploaded by ChildrensHospPhila on 09.06.2010

Transcript:
>> THAT DAY IN THE ULTRASOUND ROOM WHEN THAT TECHNICIAN LOOKED
AT US LIKE, "YOU TWO KNOW YOU'RE HAVING TWINS."
>> ON THE ULTRASOUND YOU COULD SEE, YOU KNOW, A LOT OF DETAIL
BECAUSE IT WAS A LEVEL TWO ULTRASOUND.
>> IT'S VERY UNCOMMON.
ONLY 10, 15% OF MONOCHORIONIC TWINS DEVELOP THIS TYPE
OF A SYNDROME.
>> YOU COULD TELL THEY WERE BOTH GIRLS.
>> AND FOR ONE MOMENT IT WAS EXCITING.
>> WE DON'T KNOW EXACTLY WHAT IT IS THAT CAUSES TWIN-TO-TWIN
TRANSFUSION SYNDROME.
>> I COULD SEE THE SCREEN THAT SOMETHING WAS WRONG.
THERE WASN'T ANY FLUID IN THE ONE SAC AT ALL.
>> BUT WE KNOW THAT IT HAS SOMETHING TO DO WITH THE VERY
UNIQUE NATURE OF THE WAY THE BLOOD VESSELS CONNECT IN THE PLACENTA.
>> THEY DON'T SHARE THE PLACENTA EQUALLY.
>> A DOCTOR CAME IN, TOOK A LOOK AT THESE ULTRASOUNDS.
>> AND HE DIDN'T SAY A WORD.
HE JUST WAS LOOKING AND KIND OF TAKING NOTES AND THEN HE BROUGHT
US INTO HIS OFFICE AND SHUT THE DOOR AND HE SAID,
"YOU KNOW, THIS IS GOING TO--THIS IS GOING TO BE A VERY DIFFICULT PREGNANCY."

>> TWIN-TWIN TRANSFUSION SYNDROME IS A COMPLICATED DISORDER.
>> A SERIOUS COMPLICATION OF MONOCHORIONIC
OR IDENTICAL TWIN PREGNANCIES.
>> MONOCHORIONIC MEANING THAT THEY SHARE A PLACENTA.
>> IN A MONOCHORIONIC DIAMNIOTIC PREGNANCY THERE IS ONE CHORION
WHICH IS THE OUTER SAC AND EACH TWIN IS IN ITS OWN AMNION.
SO THAT IT'S LIKE A SINGLE BALLOON WITH TWO FILLED BALLOONS INSIDE IT.
ONE TWIN, THE RECIPIENT TWIN, GETS TOO MUCH BLOOD AND THE OTHER TWIN,
THE DONOR TWIN, DOESN'T GET ENOUGH BLOOD.
>> BECAUSE THE AMOUNT OF OXYGEN AND NUTRITION GOING TO THE DONOR
BABY IS LESS THAN TO THE RECIPIENT BABY,
THEY GROW AT DIFFERENT RATES.
>> ONE TWIN WILL END UP BEING VERY LARGE, HAVING EXCESSIVE
AMNIOTIC FLUID AROUND IT OR POLYHYDRAMNIOS.
>> THE OPPOSITE KIND OF OCCURS IN THE SMALLER BABY OR THE DONOR BABY.
>> THE OTHER TWIN ON ULTRASOUND WILL SHOW ITSELF AS BEING VERY
SMALL FOR GESTATIONAL AGE.
IT WILL HAVE DECREASED AMNIOTIC FLUID OR ACTUALLY NO FLUID.
>> OVER TIME THE AMNIOTIC FLUID AROUND THE DONOR BABY SHRINKS
AWAY UNTIL LITERALLY THE BABY BECOMES SHRINK-WRAPPED ALONG
SIDE OF THE UTERINE WALL OR PLACENTA.
>> AS THIS DISEASE PROGRESSES YOU END UP SEEING CARDIAC
CHANGES IN BOTH OF THE BABIES.
>> WHEN WE BEGIN TO SEE CARDIAC CHANGES, ONE CAN HAVE SIGNIFICANT
COMPLICATIONS AS A CONSEQUENCE WHICH CAN LEAD TO EITHER RESIDUAL
ISSUES THAT THESE FETUSES FACE OR EVEN DEATH IN EITHER
THE RECIPIENT OR THE DONOR.