The twin-twin transfusion syndrome

Article Abstract:

During fetal development, communication occurs between the circulatory systems of twins. Twin-twin transfusion occurs when this communication is unbalanced, leading, for example, to anemia in one twin and an excess of red blood cells in the other. This article reviews what is known about twin-twin transfusion syndrome in the light of new research. The origin and development of the disorder is described, as are the actual anatomical differences associated with it. Besides alterations in the blood supply, differences in twin stature are the most consistent finding. Previously, diagnosis was usually made after delivery, and the symptoms of affected newborns and their placentas are described. Prenatal diagnosis had been made possible by new instrumentation, including ultrasound imaging, fetal blood sampling, heart rate monitoring, and Doppler studies of blood flow. Twin-twin transfusion syndrome can result in physical and mental deficiencies and other difficulties. When diagnosed after delivery, affected twins are treated by experienced neonatologists. Prenatal treatment is still not well established. However, current experimental techniques may soon become accepted as standard. Premature delivery is another alternative, as survival may be more favorable with extrauterine treatment of premature infants than with prenatal treatment of the disorder. Further research may allow success in the treatment of twin-twin transfusion syndrome to reach that of its diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Fetofetal transfusion

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"Macrosomic" twinning: a study of growth-promoted twins

Article Abstract:

Twins are at higher risk for morbidity and mortality; in addition, they are usually of lower birth weight than single newborns. Whether ''heavy'' (macrosomic) twins, whose average birth weight is in the top decile (heaviest 10 percent), are also at risk, was determined by evaluating 56 twin pairs who met this criterion, and comparing them with 56 twin pairs in the ninth decile. The births took place during a 10-year period at one hospital. Of particular concern were maternal variables, gestational age, birth order, weight of each twin at birth, mode of delivery, and differences in birth weight between the twins. Results showed that the average birth weights of 10th decile twins ranged between 3,035 and 4,245 grams (about 6.6 and 9.3 pounds); 19 infants were heavier than 3,600 grams (about 7.6 pounds). When compared with ninth-decile weights, those of tenth-decile twins tended to be more discordant (different from each other). Compared with twin mothers in the general population, significantly fewer women in the tenth-decile group were experiencing their first pregnancy. No differences were observed between the ninth and tenth deciles in number of previous births, maternal age or gestational age. The cesarean section rate was also similar for both groups. All newborns studied were in good health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Growth, Birth weight, Twins

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Second-breech presentation in twins - a possible adaptive measure to promote fetal growth

Article Abstract:

The possible causes of breech presentation in twins, an abnormal position of a fetus when the buttocks are presented first during labor, was studied. The delivery of twins who were both in breech position (breech-breech presentation) occurred significantly earlier in the pregnancy than delivery of twins in which the second fetus was in the vertex position, presenting the vertex of the fetal head during labor. Twins who were both in breech position weighed the same as or slightly more than other twin combinations. Breech-breech pairs may be born earlier because they may grow to critical utero-fetal proportion earlier. Another theory says that if one twin is in breech position, the other twin may arrange itself in the same position to promote growth. Breech-breech presentations diagnosed at the beginning of the third trimester of pregnancy require special care.

Case studies, Abnormalities, Complications and side effects, Breech delivery, Fetal presentation, Breech birth, Multiple birth

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