Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy
Abstract The presence of polyhydramnios and oligohydramnios is pathognomonic for twin–twin transfusion syndrome (TTTS). However, polyhydramnios of both twins can exist in TTTS in the setting of a septostomy of the dividing membrane. In prior reported cases of dual polyhydramnios TTTS, the septostomy...
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2013-05-01
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doaj-c47d2503a34745d3a8fa57e2b6688efc2020-11-25T03:51:35ZengThieme Medical Publishers, Inc.American Journal of Perinatology Reports2157-69982157-70052013-05-01030208308610.1055/s-0033-1343790Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous MicroseptostomyDavid N. Hackney0Nahla Khalek1Julie Moldenhauer2Tulin Ozcan3Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, New YorkThe Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PennsylvaniaThe Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PennsylvaniaDepartment of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, New YorkAbstract The presence of polyhydramnios and oligohydramnios is pathognomonic for twin–twin transfusion syndrome (TTTS). However, polyhydramnios of both twins can exist in TTTS in the setting of a septostomy of the dividing membrane. In prior reported cases of dual polyhydramnios TTTS, the septostomy was identified through either ultrasound or fetoscopy thus helping to establish the diagnosis of TTTS with an unusual presentation. The presented case is a set of monochorionic, diamniotic twins who presented initially with dual polyhydramnios. Subsequent ultrasound and clinical and pathologic findings were otherwise consistent with TTTS. Unlike prior reported cases, a septostomy of the dividing membrane was never identified with ultrasound or even on post delivery placental examination. However, microseptostomies were demonstrated due to the transfer of indigo carmine between the amniotic sacs at amniocentesis. Thus in the setting of TTTS concern, the diagnosis should be considered with dual polyhydramnios even if a septostomy cannot be identified.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0033-1343790twin–twin transfusion syndromepolyhydramniosmicroseptostomymonochorionicmultifetal gestation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
David N. Hackney Nahla Khalek Julie Moldenhauer Tulin Ozcan |
spellingShingle |
David N. Hackney Nahla Khalek Julie Moldenhauer Tulin Ozcan Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy American Journal of Perinatology Reports twin–twin transfusion syndrome polyhydramnios microseptostomy monochorionic multifetal gestation |
author_facet |
David N. Hackney Nahla Khalek Julie Moldenhauer Tulin Ozcan |
author_sort |
David N. Hackney |
title |
Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy |
title_short |
Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy |
title_full |
Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy |
title_fullStr |
Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy |
title_full_unstemmed |
Twin–Twin Transfusion Syndrome Presenting as Polyhydramnios in Both Fetuses Secondary to Spontaneous Microseptostomy |
title_sort |
twin–twin transfusion syndrome presenting as polyhydramnios in both fetuses secondary to spontaneous microseptostomy |
publisher |
Thieme Medical Publishers, Inc. |
series |
American Journal of Perinatology Reports |
issn |
2157-6998 2157-7005 |
publishDate |
2013-05-01 |
description |
Abstract
The presence of polyhydramnios and oligohydramnios is pathognomonic for twin–twin transfusion syndrome (TTTS). However, polyhydramnios of both twins can exist in TTTS in the setting of a septostomy of the dividing membrane. In prior reported cases of dual polyhydramnios TTTS, the septostomy was identified through either ultrasound or fetoscopy thus helping to establish the diagnosis of TTTS with an unusual presentation. The presented case is a set of monochorionic, diamniotic twins who presented initially with dual polyhydramnios. Subsequent ultrasound and clinical and pathologic findings were otherwise consistent with TTTS. Unlike prior reported cases, a septostomy of the dividing membrane was never identified with ultrasound or even on post delivery placental examination. However, microseptostomies were demonstrated due to the transfer of indigo carmine between the amniotic sacs at amniocentesis. Thus in the setting of TTTS concern, the diagnosis should be considered with dual polyhydramnios even if a septostomy cannot be identified. |
topic |
twin–twin transfusion syndrome polyhydramnios microseptostomy monochorionic multifetal gestation |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0033-1343790 |
work_keys_str_mv |
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