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>> IN A WAY, TWIN-TWIN TRANSFUSION SYNDROME
IS AN UNSOLVED PROBLEM.
WE STILL DON'T COMPLETELY UNDERSTAND THE UNDERLYING
PATHOPHYSIOLOGY, FOR INSTANCE,
AND THAT'S WHY RESEARCH IS IMPORTANT.
>> THE DISEASE, WE THINK, IS RELATED TO ABNORMAL
CONNECTIONS OF VESSELS THAT ARE SHARED BETWEEN
THE TWO TWINS.
>> EACH CASE IS REALLY UNIQUE.
IT'S ALMOST-- THE TERM WE USE,
"IT'S ALMOST LIKE A FINGERPRINT."
>> THERE IS AN ABNORMALITY OF THE VESSELS WITHIN
THE PLACENTA SUCH THAT THESE ABNORMAL CONNECTIONS LEAD
TO A CHANGE IN VOLUME, A CHANGE IN BLOOD DELIVERY BETWEEN
THE TWO TWINS.
>> THERE ARE NO TWO PLACENTAS THAT ARE EXACTLY
THE SAME.
THE NUMBER OF BRANCHES OF BLOOD VESSELS,
WHERE THEY ARE IN THE PLACENTA,
WHERE THEY GO, THE NUMBER OF COMMUNICATIONS IS UNIQUE
AND DIFFERENT FOR EACH CASE.
>> IN ADDITION TO BEING UNPREDICTABLE,
EVERY PREGNANCY IS INDEPENDENT IN TERMS OF HOW
RAPIDLY OR HOW STABLE THE CONDITION REMAINS.
>> ONE HAS TO FOLLOW THE CASE EXTREMELY CLOSELY
AND BE PREPARED FOR EVERY POSSIBLE EVENTUALITY BECAUSE
THAT MAY AFFECT FURTHER DIAGNOSTIC STUDIES
AND TREATMENT.
>> AND THAT'S WHY TREATING TWIN-TWIN TRANSFUSION
IS SO CHALLENGING.
>> EVERY PATIENT PRESENTS WITH A DIFFERENT SITUATION.
EVERY PATIENT PROGRESSES THROUGH THE DISEASE PROCESS
AND THE PREGNANCY WITH A DIFFERENT SORT OF SCENARIO.
>> SO ALL OF THOSE SCENARIOS MEAN WE HAVE TO TAILOR
THE INFORMATION ABOUT POSSIBLE TREATMENT STRATEGIES
TO THOSE INDIVIDUAL FINDINGS AT THE EVALUATION.