Twin to twin transfusion syndrome (TTTS)

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Figer-1

📄 Report Sample Line- Twin to twin transfusion syndrome (TTTS)
shows extension of the placental tissue into the base of the inter twin membrane (the lambda sign). shows decreased fluid around the donor (oligohydramnios <3cm deepest vertical pocket), stuck to the wall of the myometrium and increased fluid around the recipient (polyhydramnios >6cm deepest vertical pocket). Size of donor twin smaller than recipient. Monochorionic diamniotic twin pregnancy shows evidence of intertwin fluid discordance. while the recipient twin has a distended bladder and signs of cardiac strain. These findings are consistent with Twin-to-Twin Transfusion Syndrome (TTTS).


Conclussion: 📋 Sonographic findings indicate Twin-to-Twin Transfusion Syndrome (TTTS), characterized by amniotic fluid discordance and hemodynamic imbalance between donor and recipient twins in a monochorionic diamniotic pregnancy. Donor twin exhibits features of volume depletion, while the recipient twin shows signs of volume overload. The findings correspond to Quintero Stage II
Recommendation: Fetal echocardiography for recipient twin to assess cardiac function and risk of hydrops.

Quintero Staging System for TTTS

Stage	Sonographic Findings	Key Features
Stage I	– Oligohydramnios in donor twin (DVP < 2 cm) – Polyhydramnios in recipient twin (DVP > 8 cm) – Visible bladder in donor twin	Earliest sign with preserved urine output in donor
Stage II	– Same fluid discordance as Stage I – Bladder not visible in donor twin	Suggests worsening hypovolemia in donor
Stage III	– Abnormal Dopplers in either twin:   • Absent or reversed end-diastolic flow in UA   • Reversed flow in DV   • Pulsatile flow in UV	Indicates fetal hemodynamic compromise
Stage IV	– Hydrops fetalis in one or both twins	Severe TTTS with systemic compromise
Stage V	– Intrauterine demise of one or both twins	Final stage with fetal death

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Note: Select English to answer in English, या हिंदी चुनें तो प्रश्नों के उत्तर हिंदी में दीजिए।

1. TTTS occurs in which type of twin pregnancies? 1. TTTS किस प्रकार की ट्विन गर्भधारण में होता है?
A. Monochorionic diamniotic twins
B. Dichorionic twins
C. Monoamniotic only
D. Any multiple pregnancy equally

2. Primary pathophysiology of TTTS is: 2. TTTS की प्राथमिक रोगप्रणाली क्या है?
A. Imbalanced blood flow through placental vascular anastomoses from donor to recipient
B. Genetic mismatch between twins
C. Maternal hypertension only
D. Umbilical cord knotting only

3. Which Quintero stage describes absent bladder in donor twin and oligohydramnios? 3. कौन सा क्विन्टेरो स्टेज डोनर ट्विन में मूत्राशय अनुपस्थित और ओलिगोहाइड्रामनियास का वर्णन करता है?
A. Stage I
B. Stage II
C. Stage III
D. Stage V

4. Best initial ultrasound feature suggesting TTTS? 4. TTTS का सबसे अच्छा प्रारंभिक अल्ट्रासाउंड संकेत क्या है?
A. Discordant amniotic fluid volumes (oligo–polyhydramnios sequence)
B. Twin peak (lambda) sign
C. Two equally large bladders
D. Always fetal demise

5. First-line definitive therapy for severe TTTS (Quintero II–IV) is: 5. गंभीर TTTS (क्विन्टेरो II–IV) के लिए पहला निर्णायक उपचार क्या है?
A. Fetoscopic laser photocoagulation of placental vascular anastomoses
B. Repeated amnioreduction as sole long-term therapy
C. Immediate term delivery in all cases
D. Maternal blood transfusion

6. Which Doppler change in the donor twin indicates severe compromise? 6. डोनर ट्विन में कौन सा डॉपलर परिवर्तन गंभीर संकट का संकेत देता है?
A. Absent or reversed end-diastolic flow in umbilical artery
B. Increased fetal movements
C. Normal umbilical artery flow
D. Maternal tachycardia

7. Role of serial ultrasound surveillance in monochorionic twins is to: 7. मोनोकोरिओनिक ट्विन्स में क्रमिक अल्ट्रासाउंड निगरानी की भूमिका क्या है?
A. Detect TTTS, growth discordance and other complications early (eg every 1–2 weeks from 16 weeks)
B. Replace need for any clinical care
C. Only to assess fetal sex
D. To confirm dichorionicity

8. Short-term maternal-fetal procedure often used as temporizing measure in TTTS is: 8. TTTS में अस्थायी उपाय के रूप में अक्सर उपयोग की जाने वाली अल्पकालिक मातृ–भ्रूण प्रक्रिया क्या है?
A. Amnioreduction of the recipient sac
B. Maternal platelet transfusion
C. Fetal surgery to transplant placenta
D. No intervention is ever used

9. A recognized long-term risk after TTTS for surviving infants is: 9. TTTS के बाद जीवित शिशुओं के लिए एक पहचाना गया दीर्घकालिक जोखिम क्या है?
A. Neurodevelopmental impairment in some survivors
B. Guaranteed normal neurodevelopment in all survivors
C. Immunodeficiency
D. Permanent lung agenesis

10. Which investigation helps detect fetal anaemia/polycythaemia sequelae in TTTS/TAPS? 10. TTTS/TAPS में भ्रूणीय एनीमिक/पॉलीसाइथेमिक परिणामों का पता लगाने में कौन सी जांच मदद करती है?
A. Middle cerebral artery peak systolic velocity (MCA-PSV) Doppler
B. Maternal hemoglobin only
C. Amniocentesis for maternal DNA
D. Fetal ECG