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>> MANY TIMES TWIN-TWIN TRANSFUSION IS FIRST SUSPECTED
WHEN YOU HAVE A TWIN PREGNANCY THAT APPEARS
TO BE MONOCHORIONIC OR SHARES A PLACENTA
AND THERE'S A SIZE DIFFERENCE BETWEEN THE BABY
AND AN AMNIOTIC FLUID VOLUME DIFFERENCE.
>> THE INFORMATION THAT WE RECEIVE FROM OUR REFERRING
PHYSICIANS ALLOWS US TO BE ABLE TO ASCERTAIN HOW URGENT
WE WOULD NEED TO EVALUATE OUR PATIENTS.
>> SO WE MAKE ARRANGEMENTS VERY SHORTLY,
USUALLY WITHIN ONE TO TWO DAYS,
FOR THEM TO VISIT THE CENTER.
>> IF WE FEEL THAT BASED ON THE INFORMATION THAT WE
RECEIVE THAT THE CLINICAL SITUATION IS CRITICAL THEN
WE WILL MAKE CERTAIN TO SEE OUR PATIENTS
WITHIN 24 HOURS.
>> WHEN I INITIALLY TALK TO FAMILIES I GET A SENSE
OF WHAT THEY UNDERSTAND OF THE PREGNANCY.
I ALSO TRY TO ALLAY A LITTLE BIT OF THEIR FEAR BY TELLING
THEM THAT WE'RE NOT CERTAIN WHAT THE DIAGNOSIS IS
AND IT'S IMPORTANT FOR THEM TO COME IN FOR AN EVALUATION
SO THAT WE CAN CONFIRM THE DIAGNOSIS.
>> THERE ARE OTHER CONDITIONS THAT CAN MIMIC
THE FINDINGS.
AS A MATTER OF FACT FOR EVERY 10 REFERRALS THAT WE
GET ABOUT TWO OUT OF THE 10 PROVE TO BE SOMETHING ELSE.
>> THERE'S TYPICALLY FIVE AREAS WE LOOK AT.
IS THERE ONE PLACENTA?
ARE THEY THE SAME SEX?
IS THERE THE SAME AMOUNT OF FLUID IN ONE SAC VERSUS
THE OTHER SAC?
HOW ARE THE CORDS INSERTED?
AND THEN IMPORTANTLY, WHAT ARE THE CARDIAC
ECHO FINDINGS?
>> WHEN PATIENTS ARRIVE TO OUR CENTER FOR EVALUATION,
PART OF THEIR EVALUATION CONSISTS OF A VERY
DETAIL-ORIENTED ULTRASOUND EXAMINATION,
AS WELL AS A DETAIL-ORIENTED FETAL ECHOCARDIOGRAM.
>> BECAUSE WE BELIEVE THE ORIGINS OF THE DISEASE
OF TWIN-TWIN TRANSFUSION SYNDROME ARE CARDIOVASCULAR,
IT IS ESSENTIALLY IMPORTANT TO BEGIN THE EVALUATION
PROCESS IMPLEMENTING FETAL ECHOCARDIOGRAPHY.
>> UTILIZING THE RESULTS FROM THE EXAMINATIONS,
INCLUDING THE ULTRASOUND EXAMINATION AS WELL AS
THE FETAL ECHOCARDIOGRAM, WE CAN THEN CREATE A COMPOSITE,
WHICH ALLOWS US TO STAGE THE TWIN-TWIN TRANSFUSION SYNDROME.
>> ONCE THAT EVALUATION IS COMPLETE,
THAT SAME DAY WE SIT DOWN WITH THE FAMILY AND GO OVER
THE RESULTS OF THOSE TESTS AND EXPLAIN WHAT THEIR
OPTIONS ARE FOR THE PREGNANCY AND WHAT WOULD
MOST LIKELY BE THE SCENARIOS THAT WOULD HAPPEN DEPENDING
UPON WHICH OPTION THEY CHOSE.
>> WE TRY TO BE NON-DIRECTIVE.
WE TRY TO FIRST OF ALL PRESENT WHAT THE PROBLEM IS,
WHAT WE BELIEVE THE PATHOLOGIC PROCESS IS,
WHY IT'S PROGRESSIVE.
WE THEN PRESENT ALL THE FORMS OF THERAPY.
>> THE CONSULTATION PERIOD IS A TIME FOR FAMILIES
TO ASK AS MANY QUESTIONS AS THEY HAVE.
>> WE REALLY PUT IT OUT ON THE TABLE.
WE EDUCATE THEM ABOUT THE RISKS,
THE POTENTIAL BENEFITS, WHAT'S REPORTED
IN THE LITERATURE AS TO SURVIVALS, COMPLICATIONS,
OUTCOMES.
AND THEN WE REALLY WORK IN CONCERT WITH THE FAMILY
TO DECIDE WHAT'S THE BEST THING FOR THEM.