A RARE SEVERE OLIGO HYDRAMNIOS IUD FETAL ASCITES

anc 27yrs primi et 31wks presents vid pedal edema not relieved by rest.bp 130/80. hb 5.5gm%.urine protein 1+. sono was dono .guide treatmnt

TWIN TO TWIN TRANSFUSION SYNDROME: TWIN TO TWIN TRANSFUSION SYNDROME ( TTTTS ) ,also known as FETO-FETAL TRANSFUSION SYNDROME ( FFTS ) or TWIN OLIGOHYDRAMNIOS-POLYHYDRAMNIOS SEQUENCE ( TOPS ) Is a complication of MONOCHORIONIC, DIAMNIOTIC ( MCDA ) pregnancy in which the presence of OLIGOHYDRAMNIOS In one sac and POLYHYDRAMNIOS in another sac , results from INTERTWIN VASCULAR CONNECTIONS WITHIN THE PLACENTA . TTTTS is diagnosed based on two criteria 1) presence of monochorionic diamniotic pregnancy. 2) Polyhydramnios defined if the largest vertical pocket is >> 8 cms in one twin and Oligohydramnios defined if the largest vertical pocket is << 2 cms in the other twin. Once identified,,TTTTS is typically staged by the QUINTERO STAGING SYSTEM. STAGE I : Visible bladder in the donor twin with normal Doppler. STAGE II: Empty bladder in donor twin with normal Doppler. STAGE III : Empty bladder in donor twin with abnormal doppler. STAGE IV : Hydrops fetalis in the recipient twin. STAGE V : Demise of any twin. ANTENATAL ULTRASOUND: Twin growth discordance between the two twins. Significant difference in umbilical cord diameter. Difference in nuchal translucency between the twins in early pregnancy. RECIPIENT TWIN : Large in size with increased estimated fetal. weight Polyhydramnios. Large urinary bladder. Evidence of polycythemia Fetal hydrops. Fetal cardiomegaly. DONOR TWIN / PUMP TWIN / STUCK TWIN. the small twin with decreased estimated fetal weight appears pinned to one side of gestational sac. Evidence of fetal anemia. Oligohydramnios. Small / absent urinary bladder. THE CARDINAL PRENATAL FINDINGS ARE MONOCHORIONIC TWINS. CONCORDANT GENDER. DISCORDANT AMNIOTIC FLUID VOLUMES. Here, I would like to share my case G3 P1 L1 A1 PR LSCS Consanguinous marriage. LMP 30-9-17 GA 24 weeks USG TTTTS with Polyhydramnios and IUD of one twin and oligohydramnios of other twin . Labour induced . Delivered on 23-3-18 FIRST FETUS : Polyhydramnios and IUD. Delivered as breech BW 1.1 kg. Male SECOND FETUS: Oligohydramnios / Male / BW 600 gms PLACENTA monochorionic diamniotic. Liquor 6.5 litres for first twin. You can appreciate the size of abdomen / 24 weeks monochorionic diamniotic twins with TTTTS Pink ,polycythemic recipient twin with hydrops. Pale ,anemia twin- was alive at birth. died in few minutes. Liquor 6.5 litres. Placenta with diamniotic membranes displayed.

A CASE OF NON IMMUNE HYDROPS FETALIS : I would like to share a case of NIHF. 24 year old G 2 P 1 L 1 , 1st = FTND ,alive male child 2 years. LMP 17 - 11 - 1 7 . TIFFA scan at 22 weeks showed following features. 1 ) SEVERE OLIGOHYDRAMNIOS. 2 ) ASCITES. 3 ) ECHOGENIC BOWEL GRADE 3 4 ) ECHOGENIC FOCI IN LIVER. 5 ) MILD PLEURAL AND PERICARDIAL EFFUSION. 6 ) ABNORMALLY INCREASED PLACENTAL THICKNESS 5 CM. 7 ) INCREASED NUCHAL FOLD THICKNESS. Pregnancy was terminated. Delivered a dead male baby weighing 500 gms. Placenta thick and weighed 500 gms. Patient was not willing to undergo evaluation of NIHF.

25/F with gestation of 29 wks..developed mild SOB with lethargy, tiredness,general wkness, her HB -5.1 USG attached... respected Dr..can I go for BT .?

Differential please...and likely cause if it can be identified from the image. Primi at 18 weeks , came with USG findings suggestive of the above features....mid trimester abortion done.