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(1)

Management of Monozygotic twins

Isaac Blickstein, MD

(2)
(3)
(4)
(5)

It’s all about

Territory

(6)
(7)

It’s all about Territory

Pipelines

(8)
(9)

L. Lewi, Leuven

(10)

Velamentous insertion

(11)

Territoriality

(12)

Anastomosis

(13)

Anastomosis

Territoriality

Velamentous insertion

(14)
(15)
(16)
(17)
(18)
(19)
(20)

Shunt(s)

Cardiac overload (r) Polyhydramnios [Hormonal output (r)]

Oligohydramnios (d)

T win Oligo Polyhydramnios Sequence = TOPS

(21)

Shunt(s)

Cardiac overload (r) Polyhydramnios Hormonal output (r) Oligohydramnios (d)

T win Oligo Polyhydramnios Sequence = TOPS

(22)

Shunt(s)

Cardiac overload (r) Polyhydramnios Hormonal output (r) Oligohydramnios (d)

T win Poly Oligohydramnios Sequence = TPOS

(23)
(24)
(25)

TOPS

(26)

Crombleholme et al, 2009

(27)

Crombleholme et al, 2009

So what ?

(28)
(29)

Territoriality

(30)
(31)
(32)

IUGR in twins

Relative growth restriction

Absolute growth restriction

(33)

sIUGR in twins

Relative growth restriction

+

Absolute growth restriction

(34)

(35)
(36)
(37)

(38)
(39)

1540 g 450 g

(40)

Growth restricted MC twins

UA Doppler A/R EDF

Good

I

-

(41)

Growth restricted MC twins

UA Doppler A/R EDF

Good Bad

I II

- +

(42)

Growth restricted MC twins

UA Doppler A/R EDF

Good Intermittent Bad

I III II

- ± +

(43)

So what

?

(44)
(45)
(46)
(47)
(48)
(49)

Prognosis for the co-twin following single-twin death in MC twins

Ong et al, BJOG 2006

Dead

12% Alive, Neuro

(+) 18%

Alive, Neuro (-)

70%

(50)

In MC twins

Risk of sIUGR:

sIUFD

(51)

ISHII et al

(52)

Rescue anastomosis

(53)
(54)
(55)

•Spontaneous in 5%

•Following incomplete laser Tx for TTTS

T win Anemia Polycythemia Sequence

Large Hb difference without TTTS

(56)
(57)
(58)
(59)
(60)
(61)
(62)

Prenatal Dx of

TAPS

(63)
(64)
(65)

So what

?

(66)
(67)
(68)

Severe anemia Hyper-viscosity

Brain (other organs)

damage

(69)

(70)
(71)
(72)
(73)
(74)

MZ =

embryonic

accident

(75)

Pathogen

Zygotic splitting

(76)

Pathogen

Zygotic splitting

Malformations

(77)

Classification of malformations among multiples

Isaac Blickstein, 1999

(78)

Category

1. Malformations more common in twins than in singletons

Classification of malformations among multiples

(79)
(80)
(81)

Category

2. Malformations unique to MZs

Classification of malformations among multiples

(82)
(83)
(84)
(85)

Category

4. Deformation owing to intrauterine crowding

Classification of malformations among multiples

(86)
(87)
(88)
(89)

Category 3. Placental malformations

Classification of malformations among multiples

(90)

Size

Discordant

AFI

Dopplers Size

Hb

sIUGR

TTTS, TOPS

TTTS, sIUGR, TAPSsIUGR TAPS

(91)

Thank you

Referanslar

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