Foetal Medicine Posted By Dr Geeta B.K. MBBS DGO MRCOG Date : 05-Jul-06
A 37 years old primi was booked at antenatal clinic at 10 weeks gestational age. It was an IVF conception. Apart from routine antenatal investigations a early pregnancy scan was undertaken which revealed twin pregnancy. It was mono chorionic pregnancy with both foetuses live. Appropriate counselling was done and a repeat ultrasound scan was arranged at 18 weeks. Apparently no obvious anomalies were noticed but Doppler showed some vascular communication between the twins. Patient was explained about the findings and close foetal monitoring was advised to see the effects of "Twin to twin transfusion syndrome" ( TTTS) Pregnancy progressed uneventfully till 22 weeks and it was only then, the discordancy in foetal weight started to appear. One sac showed excessive liquor and other sac showed normal liquor. Two weekly ante natal check up, ultrasound scans and Dopplers were used to follow up. Cortico steroids were administerd at 27 -28 weeks and pediatricians were made aware about the suspected TTTS.Pregnancy was monitored with serial ultra sound , Doppler, cardio tocography(CTG)and bio physical profile. At 32 weeks one sac was having gross polyhydramnios and foetal weight discordancy was more than 500grams. The bio physical profile on smaller twin with oligohydrmnios was poor with reduced variability on CTG. However, because of the prematurity CTG could not be relied upon fully. Decision to deliver the woman was taken in order to avoid intra uterine foeatl death in one of the twins. After ounselling the couple, elective Caesarean section was performed at 33 weeks and live female twins were born with weights of 900 grams and 1600 grams. Communicating vesels and single placenta was confirmed post delivery. Both foetuses are doing well with good neonatal care. It was an interesting case of Twin to twin transfusion syndrome with mono chorionic twins.