Introduction: We present a case series of pre-viable severe twin-twin transfusion syndrome (TTTS).Clinical Picture: In year 2000, there were 16,688 deliveries in KK Women’s and Children’s Hospital. Four cases that presented before 24 weeks gestation satisfied the sonographic criteria for severe TTTS: same-sex fetuses, absence of twin peak sign, thin intertwin membrane, polyhydramnios associated with large bladder in recipient twin, and oligohydramnios and small or absent bladder in donor twin. Treatment: Amnioreduction, septostomy and termination of pregnancy were offered. Outcome: In 1 case abortion was chosen. The follow-up was at least 18 months postnatal. There was 1 intrauterine death, 2 with severe neurological handicap and 3 with normal outcome. Conclusion: Pre-viable severe TTTS is associated with significant mortality and morbidity rates and should be diagnosed promptly and managed in a tertiary fetal medicine unit with multi-disciplinary input.
Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta.
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