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The first 25 slides, exactly as they appear. The full deck has 123 content slides.
Radiology
Twin-Twin Transfusion Syndrome
Built from Obstetric Imaging
What’s inside
12 sections · 123 slides
Overview
- What you will learn
The problem in plain terms
One placenta, two babies, unequal blood sharing
- Two babies sharing one placenta
- What twin-twin transfusion syndrome means
- Donor twin versus recipient twin
- Which twins are actually at risk
- ~10%
- What happens with no treatment
- When in pregnancy it shows up
- Mild disease does not always stay mild
Why it happens
Shared vessels, one-way flow, and the hormones that follow
- The plumbing inside a shared placenta
- Three kinds of connection
- 90–95%
- Surface bridges versus deep bridges
- Surface vessel bridge seen on colour Doppler
- Reading that colour Doppler image
- Why the deep one-way bridges drive the disease
- The surface artery bridge acts as a safety valve
- Slow disease and sudden disease
- The babies then react to the imbalance
- Too much fluid in one sac, almost none in the other
- What the two-panel scan is showing you
- The donor's hormone response
- The recipient's mirror-image response
- Hormone findings that sharpen the picture
- Vessel signals change the Doppler picture too
Catching it in time
Scan every two weeks, and know the early warning signs
- Monthly scans are not enough
- The surveillance plan in practice
- What the mother should report
- Early findings that raise the risk
- Neck fluid measurements in the first trimester
- An early Doppler warning sign
- Membrane folding as an early clue
- Cord inserting into membrane rather than placenta
- Why that cord insertion matters
- Can we see the protective bridges?
- Other clues, and their limits
Making the diagnosis
One essential finding, then five stages
- The finding you cannot do without
- The measurement that defines it
- Measuring the deepest fluid pocket in the recipient's sac
- Where the thresholds are argued over
- Stage II: the empty bladder
- Umbilical artery flow that stops between beats
- Reading the umbilical artery tracing
- Reversed a-wave in the ductus venosus
- Reading the ductus venosus tracing
- Stages IV and V
- The five stages in order
- How to use the staging table
- Staging of Twin-Twin Transfusion Syndrome
- What staging is good for
- Growth problems sit outside the staging
- Cases that break the usual pattern
- What else can look like TTTS
The recipient's heart
Why every TTTS pregnancy needs fetal echocardiography
- Screen every shared-placenta twin for heart defects
- Heart damage the baby acquires
- Leaking tricuspid valve in the recipient twin
- What the two heart panels show
- Muscle thickens as the strain continues
- Narrowed pulmonary valve with turbulent flow
- How the outflow becomes obstructed
- How often the heart is affected
- Blocked outflow in the recipient
- Measuring how well the heart works
- Echocardiography in day-to-day practice
Magnetic resonance imaging
A second look, mainly at the brain
- Where MRI adds something
- When MRI is usually ordered
Treatment
Laser, amnioreduction, and what the trials showed
- Three things have been tried
- All three major trials stopped early
- Reading the laser versus drainage trial
- Randomized Trial of Laser Photocoagulation Versus Amnioreduction
- Where laser stands today
- Why sealing the vessels works
- How a laser procedure runs
- Selective sealing beats sealing everything
- What can go wrong with laser
- ~10%
- Why septostomy was abandoned
- When drainage is still the right choice
- Refer before you intervene
- Harder choices in severe cases
- The argument over mild disease
- Where the stage I debate has landed
After laser surgery
Leftover vessels, recurrence, and weekly checks
- Not every vessel gets sealed
- What can come back
- Where TAPS comes from
- The Solomon technique
- Follow-up after surgery
Outcomes
Survival, the heart's recovery, and the brain
- 50–70%
- Survival by stage in the Eurofetus trial
- What the pooled evidence shows
- Reading the pooled laser series
- Perinatal Outcomes of Twin-Twin Transfusion Syndrome Pregnancies Treated With Fetoscopic Laser Photocoagulation
- Perinatal Outcomes of Twin-Twin Transfusion Syndrome Pregnancies Treated With Fetoscopic Laser Photocoagulation (continued)
- Pooled laser outcomes as printed in the book
- Who is most likely to die after laser
- The heart usually recovers
- Brain outcomes are the real concern
- Why some survivors are injured
- Other things that shape brain outcome
- Imaging the brain, and when
- Chorionicity and long-term development
Delivery and referral
Timing the birth, and what the referring doctor must know
- When to deliver
- Why testing continues even after a good laser
- What the referring physician needs to know
- The pathway from suspicion to delivery
Key points
What to carry away
- Key points: finding it
- Key points: treating it
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- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition