Twin to Twin. Crystal Duffy

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      Foreword

      Having more than one baby in a pregnancy has always intrigued pregnant women. Perhaps it is considered a blessing by some to increase a family by two at one time. When I started my residency training in Obstetrics and Gynecology, I remember reading the phrase “the human womb is only designed to carry one fetus at a time with any degree of biological grace.” Indeed, some forty years later, I have come to appreciate the truth in this statement. In those early years of my career, one in eighty pregnant women carried twins. The advent of assisted reproductive technologies (IVF and other methods) and a growing trend to defer motherhood until later in life have increased the incidence of twins to one in thirty pregnancies.

      Once, all twin pregnancies were treated the same. Now, we know that identical or monochorionic (MC) twins can develop severe complications as often as four out of ten cases. This type of twinning is rare—only three out of 1000 pregnancies. It is a chance of nature, although the incidence is reported to be higher in IVF pregnancies. One of the complications of MC twins is severe twin-twin transfusion syndrome (TTTS)—this occurs in only 10 percent of these pregnancies. Shared blood vessels in the single placenta allow for blood movement between the patient‘s unborn babies—one becomes a “donor” and one a “recipient.” Without treatment the loss of both twins occurs in 90 percent of cases. Some thirty years ago, in utero laser therapy was introduced to spot weld these connecting blood vessels using a small telescope СКАЧАТЬ