{"id":290,"date":"2015-06-12T01:51:26","date_gmt":"2015-06-12T01:51:26","guid":{"rendered":"https:\/\/depts.washington.edu\/usrad\/?page_id=290"},"modified":"2022-02-04T20:55:29","modified_gmt":"2022-02-04T20:55:29","slug":"twin-to-twin-transfusion-syndrome","status":"publish","type":"page","link":"https:\/\/depts.washington.edu\/usrad\/twin-to-twin-transfusion-syndrome\/","title":{"rendered":"Twin to Twin Transfusion Syndrome"},"content":{"rendered":"

TTTS Protocol<\/strong><\/p>\n

 <\/p>\n

Here is the template for our initial US of a TTTS patient – blue underlined are the choices:<\/p>\n

 <\/p>\n

Type of Gestation:<\/strong>\u00a0TWINS<\/strong>\u00a0–\u00a0Monochorionic, diamniotic, Monochorionic, monoamniotic<\/strong><\/a>.<\/p>\n

TTTS evaluation<\/strong><\/p>\n

 <\/p>\n

Twin A<\/strong>\u00a0RECIPIENT<\/strong><\/a>\u00a0<\/strong>(boy, female, girl, SECRET<\/a>) in\u00a0breech, cephalic, transverse, variable<\/a>\u00a0presentation on\u00a0inferior, left, right<\/a>.<\/p>\n

Normal fetal cardiac activity and fetal movement was seen.<\/p>\n

 <\/p>\n

SIZE<\/u><\/strong><\/p>\n

Fetal size is\u00a0appropriate, constitutionally small, decreased, increased, small<\/a>\u00a0for gestational age.<\/p>\n

 <\/p>\n

ANATOMY<\/u><\/strong><\/p>\n

The following fetal structures were observed and appeared normal:\u00a0 Lateral ventricles, choroid plexus, biparietal diameter level,\u00a0cavum septum pellucidum,\u00a0cerebellum and cisterna magna, thorax, diaphragm, nuchal skin thickness,\u00a0orbits and lenses,\u00a0upper lip and nostrils, profile, transverse and longitudinal spine, cord insertion, three vessel umbilical cord,diaphragm,\u00a0stomach, kidneys,\u00a0female, male, SECRET<\/a>\u00a0genitalia, all four extremities were examined in detail including long bones.<\/p>\n

 <\/p>\n

Bladder is\u00a0empty, full, small but visible<\/a><\/strong><\/p>\n

Hydrops present, No evidence of hydrops<\/a><\/strong><\/p>\n

 <\/p>\n

Cardiac Anatomy:<\/u><\/strong><\/p>\n

Rate and rhythm:<\/strong><\/p>\n

Normal cardiac rate and sinus rhythm were identified.<\/p>\n

Structural anatomy:<\/strong><\/p>\n

A 4 chamber view of the heart confirmed normal situs and axis within the thorax.\u00a0 The ventricles are symmetric.\u00a0 The mitral and tricuspid valves are normally mobile and normally placed. The interventricular septum is a normal size, small septal defects cannot be completely ruled out. The interatrial septum is identified with a normally mobile foramen ovale. The inferior and superior vena cava enter appropriately into the right atrium. Aortic outflow in the long axis view is normal. The aortic valve is identified and appears normally placed. Aortic arch is aligned to the left ventricle and appears normal. Pulmonic outflow was visualized in a short axis view. The pulmonary valve was identified and appears normally placed.\u00a0 The three vessel view was normally visualized.<\/p>\n

 <\/p>\n

Lateral ventricles:\u00a0\u00a0XX\u00a0mm<\/p>\n

No evidence of ventriculomegaly.<\/p>\n

 <\/p>\n

Dopplers<\/u><\/strong><\/p>\n

Umbilical artery Dopplers:<\/strong><\/p>\n

S\/D:\u00a0XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 PI:\u00a0XX<\/p>\n

AEDF:\u00a0cyclical, intermittent, no, yes<\/a>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 REDF:\u00a0cyclical, no, yes<\/a><\/p>\n

Middle cerebral artery:<\/strong><\/p>\n

PI:\u00a0XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 PSV MoM:\u00a0XX<\/p>\n

Ductus venosus:<\/strong><\/p>\n

PI:\u00a0XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Absent A wave flow in the ductus venosus, Completely normal flow in the ductus venosus, Decreased A wave flow in the ductus venosus, Reversed A wave flow in the ductus venosus<\/a><\/p>\n

Umbilical vein:<\/strong><\/p>\n

Non-pulsatile, Pulsatile<\/a><\/strong>\u00a0umbilical vein flow.<\/p>\n

Cardiac:<\/strong><\/p>\n

Mild, Moderate, No evidence of, Severe, Trivial<\/a><\/strong>\u00a0tricuspid regurgitation<\/p>\n

TEI Index:<\/strong><\/p>\n

Right:\u00a0 XX \u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0Abnormal, Borderline, Normal<\/a><\/p>\n

Left:\u00a0\u00a0\u00a0 XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0Abnormal, Borderline, Normal<\/a><\/p>\n

 <\/p>\n

Placental Position<\/strong><\/p>\n

Placental position is\u00a0anterior, anterior fundal, left lateral, posterior, posterior fundal, right lateral<\/a>.<\/p>\n

 <\/p>\n

Placental Umbilical Cord Insertion<\/strong><\/p>\n

The placental umbilical cord insertion is\u00a0Central right, Eccentric Left, Left, left and appears velamentous. , marginal left, marginal right, Right, velamentous left, velamentous right<\/a><\/p>\n

 <\/p>\n

Amniotic fluid:<\/strong><\/p>\n

The amniotic fluid volume is\u00a0decreased, high normal, increased, low normal , normal<\/a>, largest single vertical pocket measures\u00a0XXX\u00a0cm.<\/p>\n

 <\/p>\n

______________________________________________________________________________<\/p>\n

 <\/p>\n

 <\/p>\n

Twin B<\/strong>\u00a0DONOR<\/strong><\/a>\u00a0<\/strong>(boy, girl, SECRET<\/a>) in\u00a0breech, cephalic, transverse<\/a>\u00a0presentation on\u00a0left, right, superior<\/a>.<\/p>\n

Normal fetal cardiac activity and fetal movement was seen.<\/p>\n

 <\/p>\n

SIZE<\/u><\/strong><\/p>\n

Fetal size is\u00a0appropriate, constitutionally small, decreased, increased, large, small, small normal<\/a>\u00a0for gestational age.<\/p>\n

 <\/p>\n

ANATOMY<\/u><\/strong><\/p>\n

The following fetal structures were observed and appeared normal:\u00a0 Lateral ventricles, choroid plexus, biparietal diameter level,\u00a0cavum septum pellucidum,\u00a0cerebellum and cisterna magna, thorax, diaphragm, nuchal skin thickness,\u00a0orbits and lenses,\u00a0upper lip and nostrils, profile, transverse and longitudinal spine, cord insertion, three vessel umbilical cord,diaphragm,\u00a0stomach, kidneys,\u00a0female, male, SECRET<\/a>\u00a0genitalia, all four extremities were examined in detail including long bones.<\/p>\n

 <\/p>\n

Bladder is\u00a0empty, full, small but visible<\/a><\/strong><\/p>\n

Hydrops present, No evidence of hydrops<\/a><\/strong><\/p>\n

 <\/p>\n

Cardiac Anatomy:<\/u><\/strong><\/p>\n

Rate and rhythm:<\/strong><\/p>\n

Normal cardiac rate and sinus rhythm were identified.<\/p>\n

Structural anatomy:<\/strong><\/p>\n

A 4 chamber view of the heart confirmed normal situs and axis within the thorax.\u00a0 The ventricles are symmetric.\u00a0 The mitral and tricuspid valves are normally mobile and normally placed. The interventricular septum is a normal size, small septal defects cannot be completely ruled out. The interatrial septum is identified with a normally mobile foramen ovale. The inferior and superior vena cava enter appropriately into the right atrium. Aortic outflow in the long axis view is normal. The aortic valve is identified and appears normally placed. Aortic arch is aligned to the left ventricle and appears normal. Pulmonic outflow was visualized in a short axis view. The pulmonary valve was identified and appears normally placed.\u00a0 The three vessel view was normally visualized.<\/p>\n

 <\/p>\n

Lateral ventricles:\u00a0\u00a0XX\u00a0mm<\/p>\n

No evidence of ventriculomegaly.<\/p>\n

 <\/p>\n

Dopplers<\/u><\/strong><\/p>\n

Umbilical artery Dopplers:<\/strong><\/p>\n

S\/D:\u00a0XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 PI:\u00a0XX<\/p>\n

AEDF:\u00a0Cyclical, Intermittent, no, yes<\/a>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 REDF:\u00a0Cyclical, intermittent, no, yes<\/a><\/p>\n

Middle cerebral artery:<\/p>\n

PI:\u00a0XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 PSV MoM:\u00a0XX<\/p>\n

Ductus venosus:<\/strong><\/p>\n

PI:\u00a0XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Absent\u00a0 A wave flow in the ductus venosus, Completely normal flow in the ductus venosus, Decreased A wave flow in the ductus venosus, Reversed A wave flow in the ductus venosus<\/a><\/p>\n

Umbilical vein:<\/strong><\/p>\n

Non-pulsatile, Pulsatile<\/a><\/strong>\u00a0umbilical vein flow.<\/p>\n

Cardiac:<\/strong><\/p>\n

Mild, Moderate, No evidence of, Severe, Trivial<\/a><\/strong>\u00a0tricuspid regurgitation<\/p>\n

TEI Index:<\/strong><\/p>\n

Right:\u00a0 XX \u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0Abnormal, Borderline, Normal<\/a><\/p>\n

Left:\u00a0\u00a0\u00a0 XX\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0Abnormal, Borderline, Normal<\/a><\/p>\n

 <\/p>\n

Placental Umbilical Cord Insertion<\/strong><\/p>\n

The placental umbilical cord insertion is\u00a0Eccentric Right, eccentric superior, inferior right sided, Left, marginal left, marginal right, Right, velamentous left, velamentous right<\/a>.<\/p>\n

 <\/p>\n

Amniotic fluid:<\/strong><\/p>\n

The amniotic fluid volume is\u00a0decreased, increased, low normal, normal, subjectively reduced<\/a>, largest single vertical pocket measures\u00a0XXX\u00a0cm.<\/p>\n

 <\/p>\n

TRANSVAGINAL SCAN<\/u><\/strong><\/p>\n

Cervix appears\u00a0XX\u00a0cm long by transvaginal scan.<\/p>\n

 <\/p>\n

SUMMARY<\/u><\/strong><\/p>\n

    \n
  1. Concordantasymmetrically, symmetrically<\/a>grown\u00a0monochorionic diammiotic, monochorionic monoammiotic<\/a>\u00a0twin gestation at\u00a0XX\u00a0weeks and\u00a0XX\u00a0days.\u00a0 Inter twin growth discordance is XX %.<\/li>\n
  2. Fetal anatomy appears normal for both babies within the limits of second trimester ultrasound.<\/li>\n
  3. Detailed cardiac examination appears normal, although small septal defects cannot be completely ruled out.<\/li>\n
  4. Cervical examination appears normal.<\/li>\n
  5. Evidence for Twin to Twin Transfusion Syndrome Stage1<\/a>.<\/li>\n<\/ol>\n

     <\/p>\n

    IMPRESSION:<\/u><\/strong><\/p>\n

     <\/p>\n

    Recommended Follow Up:<\/u><\/strong><\/p>\n

     <\/p>\n

    Thank you for the opportunity to participate in her care.\u00a0 Please see consultation letter.<\/u><\/strong><\/p>\n

    \u00a0<\/strong><\/p>\n

     <\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    TTTS Protocol   Here is the template for our initial US of a TTTS patient – blue underlined are the choices:   Type of Gestation:\u00a0TWINS\u00a0–\u00a0Monochorionic, diamniotic, Monochorionic, monoamniotic. TTTS evaluation   Twin A\u00a0RECIPIENT\u00a0(boy, female, girl, SECRET) in\u00a0breech, cephalic, transverse, variable\u00a0presentation on\u00a0inferior, left, right. Normal fetal cardiac activity and fetal movement was seen.   SIZE Fetal…<\/p>\n

    Read more<\/a><\/div>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":85,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":"","iawp_total_views":54},"acf":[],"_links":{"self":[{"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/pages\/290"}],"collection":[{"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/comments?post=290"}],"version-history":[{"count":1,"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/pages\/290\/revisions"}],"predecessor-version":[{"id":291,"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/pages\/290\/revisions\/291"}],"wp:attachment":[{"href":"https:\/\/depts.washington.edu\/usrad\/wp-json\/wp\/v2\/media?parent=290"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}