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SCREENING FOR TWIN-TWIN TRANSFUSION SYNDROME AT 11-14 WEEKS OF PREGNANCY: THE KEY ROLE OF DUCTUS VENOSUS BLOOD FLOW ASSESSMENT.

5) Ultrasound Obstet Gynecol. 2010 Feb;35(2):142-8.

Matias A, Montenegro N, Loureiro T, Cunha M, Duarte S, Freitas D, Severo M.

OBJECTIVES: A discrepancy in crown-rump length (CRL) and/or nuchal translucency thickness (NT) between monochorionic twins has been found to be associated with an increased risk of twin-twin transfusion syndrome (TTTS). As one of the most plausible mechanisms for increased NT is hemodynamic imbalance and cardiac dysfunction, indirectly manifested by abnormal blood flow in the ductus venosus (DV), we aimed to clarify the role of DV blood flow assessment in identifying those monochorionic twins more prone to develop TTTS. METHODS: We present 99 cases of monochorionic diamniotic twin pregnancies in which CRL, NT and DV blood flow were evaluated at 11-14 weeks’ gestation. RESULTS: Discrepant values of CRL were not predictive of TTTS development. Intertwin NT discrepancy >or= 0.6 mm had a sensitivity of 50.0% and a specificity of 92.0%. The presence of at least one abnormal blood flow waveform in the DV was associated with a relative risk for developing TTTS of 11.86 (95% CI, 3.05-57.45), with a sensitivity of 75.0% and a specificity of 92.0%. The combination of abnormal DV blood flow with NT discrepancy >or= 0.6 mm yielded a relative risk for the development of TTTS of 21 (95% CI, 5.47-98.33). CONCLUSIONS: Both intertwin discrepancy in NT and abnormal flow in the DV in monochorionic twins may represent early manifestations of hemodynamic imbalance between donor and recipient. In these pregnancies, in addition to NT measurement at 11-14 weeks, the Doppler assessment of DV blood flow significantly increases the performance of screening for those at risk of developing TTTS.

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Recurrent partial hydatidiform mole, with a first twin pregnancy, after treatment with clomiphene citrate.

Andrei Adrian Tica1, Oana Sorina Tica1, Claudia Valentina Georgescu, Francisc Mixich, Vlad Justin Tica, Sabina Berceanu, Elena Ebanca, Anca Patrascu, Cristina Simionescu

We want to present a patient, treated for three months with clomiphen citrate after 5 years of infertility, which developed a twin pregnancy, one degenerated into a partial hydatidiform mole and the other into a very early embryo death. The karyotype was a mosaic one: 63% of metaphases showed triploidy – 69 XXX and 37% diploidy – 46 XX. Despite all medical advice, she returned 8 months later with a new pregnancy, which proved to be a new partial hydatidiform mole, this time a single one. Karyotype was, also, a triploidy – 69 XXX. more

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LASER THERAPY AND SERIAL AMNIOREDUCTION AS TREATMENT FOR TWIN-TWIN TRANSFUSION SYNDROME: A METAANALYSIS AND REVIEW OF LITERATURE.

Am J Obstet Gynecol. 2008 Feb;198(2):147-52.
Rossi AC, D’Addario V.

OBJECTIVE: The objective of the study was to review current controversy on laser therapy (LT) vs serial amnioreduction (SA) performed for twin-twin transfusion syndrome (TTTS). STUDY DESIGN: A search in PubMed from 1997-2007 was performed. Inclusion criteria were diamniotic monochorionic pregnancy, TTTS diagnosed with standard parameters, and peri- and neonatal outcomes well defined. more

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