Contributors |
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vii | |
Preface |
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ix | |
Introduction |
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xix | |
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Section 1 Where did We Come from? |
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3 | (16) |
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3 | (2) |
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Fetal Diagnosis and Therapy |
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5 | (2) |
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7 | (4) |
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11 | (8) |
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Section 2 Why does TTTS Occur? |
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2 The Hidden Costs of Monochorionicity |
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19 | (5) |
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The Magnitude of the Problem |
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19 | (1) |
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Apparent and Hidden Costs of Monochorionic Twins |
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20 | (4) |
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20 | (1) |
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20 | (1) |
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21 | (1) |
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Twin-to-Twin Transfusion Syndrome |
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21 | (1) |
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21 | (1) |
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22 | (1) |
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Natural History of Monochorionic Pregnancies |
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22 | (1) |
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22 | (2) |
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24 | (6) |
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24 | (1) |
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Early Placental Development |
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25 | (1) |
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Chorionic Plate Architecture |
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26 | (1) |
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A Hypothesis Regarding Zygosity, Chorionicity, The Intertwin Membrane and Vascular Connections |
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27 | (3) |
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30 | (14) |
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Placental Pathophysiology |
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30 | (5) |
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Arteriovenous Anastomoses |
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30 | (2) |
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32 | (1) |
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33 | (1) |
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34 | (1) |
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35 | (9) |
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35 | (1) |
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36 | (2) |
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Peripheral Doppler Abnormalities |
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38 | (1) |
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38 | (6) |
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5 Color Injection and Digital Angiography |
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44 | (15) |
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Explaining Clinical Symptoms of Monochorionic Twins through Postnatal Correlation with the Placenta |
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44 | (3) |
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Correlating Prenatal Sonographic and Intrauterine Laser Findings of Monochorionic Twins with the Placental Vasculature by Color Injections |
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47 | (1) |
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Computer Angiography of Placental Vessels in Monochorionic Multiples |
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48 | (11) |
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59 | (5) |
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59 | (2) |
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Determining the Natural History of Twin-to-Twin Transfusion Syndrome |
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61 | (3) |
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64 | (22) |
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The Monochorionic Placenta |
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64 | (15) |
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Signs and Effects of Volume Imbalance |
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65 | (12) |
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Signs and Effects of Nutrient Imbalance---Fetal Growth Discordance |
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77 | (1) |
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Discordant Fetal Anomalies |
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78 | (1) |
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Clinical Evolution and Implications for Surveillance and Risk Assessment |
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79 | (7) |
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86 | (8) |
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Diagnosis of Chorionicity |
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86 | (2) |
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First Trimester Ultrasound Examination |
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86 | (1) |
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Second Trimester Ultrasound Examination |
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86 | (1) |
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Risk Stratification for Monochorionic Twins |
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87 | (1) |
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Ultrasound Surveillance of the Monochorionic Twin Gestation |
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88 | (1) |
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Diagnosis of Twin-to-Twin Transfusion Syndrome |
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89 | (5) |
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94 | (6) |
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94 | (1) |
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95 | (1) |
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96 | (4) |
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100 | (7) |
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Risk of Spontaneous Preterm Birth in Twins |
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100 | (1) |
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Cervical Length and the Risk of Preterm Birth |
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100 | (1) |
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Interventions to Prevent Preterm Birth in the Setting of a Short Cervix |
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101 | (1) |
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Interventions for Short Cervix in the Setting of TTTS |
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102 | (1) |
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103 | (4) |
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Section 4 When does TTTS Occur? |
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11 Acute Twin-to-Twin Transfusion Syndrome |
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107 | (7) |
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107 | (2) |
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109 | (1) |
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109 | (3) |
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112 | (1) |
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112 | (2) |
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114 | (7) |
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Prevalence of Feto-Fetal Transfusion Syndrome (FFTS) in Triplets |
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114 | (1) |
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FFTS in Dichorionic vs Monochorionic Triplets |
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114 | (1) |
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Outcomes with No Treatment |
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114 | (1) |
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115 | (2) |
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115 | (1) |
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115 | (2) |
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117 | (1) |
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Counseling and Ethical Considerations |
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117 | (1) |
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117 | (4) |
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Section 5 How do We Treat TTTS? |
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121 | (9) |
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121 | (1) |
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121 | (1) |
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122 | (1) |
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122 | (1) |
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122 | (1) |
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122 | (1) |
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122 | (2) |
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124 | (1) |
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125 | (1) |
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Perioperative Care and Follow-up |
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125 | (1) |
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125 | (1) |
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126 | (4) |
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130 | (12) |
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130 | (1) |
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130 | (12) |
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130 | (5) |
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Cardiovascular Morbidity and Right Ventricular Outflow Tract Obstruction |
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135 | (1) |
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135 | (1) |
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136 | (1) |
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Antenatal Hypoxic-Ischemic Lesions |
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137 | (1) |
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137 | (5) |
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142 | (11) |
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142 | (2) |
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Monitoring TTTS Pregnancies Following Laser Surgery |
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143 | (1) |
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Complications: What to Look for |
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144 | (9) |
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Preterm Prelabor Rupture of Membranes |
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144 | (1) |
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144 | (1) |
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Ruptured Intertwin Membrane |
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145 | (1) |
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Single Fetal Death: What to Do? |
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145 | (1) |
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Fetal Brain Damage and the Role of MRI |
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146 | (1) |
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Limb Reduction and Amniotic Bands |
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146 | (1) |
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147 | (1) |
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Residual Anastomoses after Laser |
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147 | (6) |
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153 | (6) |
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The Ethics of Non-Directive and Directive Counseling in the Informed Consent Process |
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153 | (6) |
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Ethically Justified Decision-Making Pathway |
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153 | (6) |
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159 | (4) |
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Index |
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163 | |