Twin-to-twin transfusion syndrome: a subset of the twin oligohydramnios-polyhydramnios sequence.
OBJECTIVE
Our purpose was to assess the adequacy of currently accepted criteria for the diagnosis of twin-to-twin transfusion syndrome.


METHODS
Between April 1991 and February 1992 nine consecutive women with twin gestations and ultrasonographic findings of marked growth discordance, coexistent oligohydramnios-polyhydramnios, monochorionic placenta, and same sex of the fetus in the second trimester were evaluated. Mean gestational age at diagnosis was 19 weeks 5 days +/- 5 weeks, and mean growth discordance was 34% +/- 9%. Seven women underwent attempted sequential amniocentesis and cordocentesis at 23 weeks 6 days +/- 2 weeks 4 days to obtain amniotic fluid and cord blood from each fetus. Type O negative, leucocyte-poor, washed adult red blood cells were transfused into the small, oligohydramnic twin during cordocentesis; immediately afterward blood from the polyhydramnic twin was tested with the Kleihauer-Betke stain.


RESULTS
The combined procedure was successful in six (86%) of the cases attempted. True twin-to-twin transfusion was confirmed in only four (44%) of those initially identified by ultrasonographic criteria. Hemoglobin difference > 5 g/dl was present in only one of the four cases, and in this case the recipient was anemic.


CONCLUSIONS
Currently accepted criteria are insufficient for the diagnosis of true twin-to-twin transfusion. Ultrasonographic findings of marked growth discordance, coexistent oligohydramnios-polyhydramnios, monochorionic placenta, and same sex identify the twin oligohydramnios-polyhydramnios sequence.
Bruner
J P
JP
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232-2519.
Rosemond
R L
RL
D000649:Amniocentesis; D017218:Cordocentesis; D005260:Female; D005312:Fetal Blood / Q000737:chemistry / Q000166:cytology; D005317:Fetal Growth Retardation / Q000209:etiology*; D005330:Fetofetal Transfusion / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005865:Gestational Age; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016104:Oligohydramnios / Q000209:etiology*; D006831:Polyhydramnios / Q000209:etiology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011272:Pregnancy, Multiple; D012156:Reticulocytes; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal
D006454:Hemoglobins