Argumentative Analysis: Twin-To-Twin Transfusion Syndrome

Misty is a 40yo, G2 P1001, who is currently 17 weeks 2 days. She was initially seen for her monochorionic twin gestation. At that time, the plan was to follow-up through your office. She was referred last week for transfer of care and is now being followed through our office. At last weeks ultrasound there was a fairly significant discordance at 31%, although twin A was not IUGR. She is here today for twin-to-twin transfusion syndrome check.

On ultrasound there is a live monochorionic twin gestation. Twin A is breech and twin B is cephalic. Amniotic fluid appears somewhat lower for twin A, although there was a 2 cm pocket on either side of the membrane. Bladders were seen on both babies. We did note female fetuses at today’s exam.
I did start to discuss twin-to-twin transfusion syndrome given the fluid and growth discrepancy. I scheduled her to return early next week. That will give us plenty of time to get her to Cincinnati should she appear to have twin-to-twin transfusion syndrome. There is also still a possibility for unequal placental sharing. We will get her scheduled into our Global practice moving forward since she will have several visits. I scheduled her to return next week to evaluate for twin-to-twin transfusion syndrome and the following week for anatomy unless there is evidence of twin-to-twin transfusion syndrome next week and we will do that prior to referring her to