Question 264 · LEK · Multiple pregnancy
In week 27 of diamniotic monochorionic twin pregnancy, one of the foetuses was found to have oligohydramnios, collapsed bladder, and reduced fetal movement, while the other had overfull bladder and generalised oedema. The diagnosis should be:
- A. selective intrauterine growth restriction (sIUGR), and the treatment should be medical observation and another ultrasound after two weeks.
- B. reversed flow syndrome, and the treatment should be a sclerosant injected into the artery of the acardiac foetus.
- C. twin-to-twin transfusion syndrome (TTTS), and the treatment should be fetoscopic lasercoagulation of blood vessels connections between the twins.
- D. twin anaemia-polycythemia sequence, and the treatment should be urgent termination of pregnancy via the caesarean section.
- E. comorbidity of gestational trophoblastic disease, and the treatment should be urgent termination of pregnancy via the caesarean section.
Hint
In monochorionic twins, opposite extremes of amniotic fluid and bladder filling suggest unbalanced placental vascular anastomoses.
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