title: A case series of pre-viable severe twin-twin transfusion syndrome.
abstract: BACKGROUND
  We present a case series of pre-viable severe twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  In year 2000, there were 16,688 deliveries in KK Women's and Children's Hospital. Four cases that presented before 24 weeks gestation satisfied the sonographic criteria for severe TTTS: same-sex fetuses, absence of twin peak sign, thin intertwine membrane, polyhydramnios associated with large bladder in recipient twin, and oligohydramnios and small or absent bladder in donor twin.
  
  
  METHODS
  Amnioreduction, septostomy and termination of pregnancy were offered.
  
  
  RESULTS
  In 1 case abortion was chosen. The follow-up was at least 18 months postnatal. There was 1 intrauterine death, 2 with severe neurological handicap and 3 with normal outcome.
  
  
  CONCLUSIONS
  Pre-viable severe TTTS is associated with significant mortality and morbidity rates and should be diagnosed promptly and managed in a tertiary fetal medicine unit with multi-disciplinary input.
authors: Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899. wee.hy@kkh.com.sg
authors: H Y
authors: HY
authors: Wee
authors: T Y
authors: TY
authors: Tan
authors: P C
authors: PC
authors: Khoo
authors: P
authors: P
authors: Agarwal
authors: G S
authors: GS
authors: Yeo
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D016104:Oligohydramnios / Q000000981:diagnostic imaging* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D012494:Sampling Studies; D012720:Severity of Illness Index; D012846:Singapore; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal