Ahmet Baschat, M.D., M.B. B.CH. B.A.O., fetal therapy specialist, discusses newly published ISUOG guidance that addresses the role of ultrasound in the care of uncomplicated twin pregnancy and those complicated by TTTS, sFGR, TAPS, TRAP sequence, conjoined twins and IUD. Learn more from this publication:
https://pubmed.ncbi.nlm.nih.gov/26577371/ Hello, my name is Ahmed Board and I'm the director of the Johns Hopkins Center for fetal Therapy. And in this short video, I'd like to tell you our outcomes with our personal care approach to identical twins. When a twin pregnancy arises from two fertilized eggs, it is obligatory that it is a non identical twin pregnancy. There is no connection between the two babies and you can have a girl and a boy in the same uterus or um they can have the identical gender. However, when a twin pregnancy arises from a single fertilized egg, then there is the risk that you get an identical twin pregnancies where both babies are identical and they share a single placenta and that can give rise to a series of complications that you require dedicated monitoring. For the good news is that you can identify babies at risk as early as the first trimester by documenting a single placenta with two gestational sacks. Once you know that then you can monitor for the top three problems that we get most of referrals for looking at sign of volume imbalance allows you to detect whether one baby is over or under hydrated, looking for signs of fetal anemia and sick blood in the other baby, gives you an opportunity to pick up this complication and looking at the size and the fluid of both babies, you get an idea of the placenta is equally shared between babies. These three conditions that have different specific signs are known as T TT S taps or twin anemia, poly artemia sequence and select a fetal growth restriction. Now, for patients that present with TDTS, the primary treatment that we offer is foss copic laser surgery. And it's important to recognize that this technique has significantly advanced over the last decades. Initially, laser surgery oriented itself at the equator and basically took more of the placenta away from the smaller twin that may have been necessary. The selective procedure targets the vessels at their meeting point and improved survival. But one of the problems is recurrent risks which might be as high as 15 per cent. And over a decade ago, we described the Solomon laser technique that also lasers the equator. And what we showed at that time is significant reduction in recurrence rates. We have now managed over 450 pregnancies at the Johns Hopkins Center for fetal therapy. And in the beginning of this year, have published our data with Solomon Laser, which basically shows significantly improved outcomes to what was previously reported. There's an over 80% chance of survival for recipient and donor twins. The only babies at risk that require special management considerations are those SFGR pregnancies with significant placental issues. And our recurrence rate is well below 3%. This year. At the annual meeting of the Society for Maternal Fetal Medicine, we will be presenting our data for the management of taps using an approach where we use both laser surgery, exchange and blood transfusions in other cases or a specialized monitoring protocol that allows us to build a safety net. So where we can safely monitor the pregnancies. But we have also developed in SFGR, which can complicate up to 30 per cent of TFS pregnancies. I thank you for your attention.