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Fetal hemoglobin changes in the twin oligohydramnios-polyhydramnios sequence
S G Carroll1, A McLennan, D J Maxwell
1Fetal Medicine Unit, Guy's Hospital, London, UK.
Summary
Twin-to-twin transfusion syndrome (TTTS) in monochorionic pregnancies may occur without significant fetal hemoglobin changes. Some cases of TTTS with oligohydramnios-polyhydramnios may not show altered hemoglobin levels.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Fetal Physiology
Background:
- Monochorionic pregnancies are at risk for twin-to-twin transfusion syndrome (TTTS).
- TTTS is characterized by unequal blood flow between fetuses, leading to potential complications.
- Diagnosis often involves growth discordance and amniotic fluid abnormalities (oligohydramnios-polyhydramnios).
Purpose of the Study:
- To investigate fetal hemoglobin concentration in monochorionic twins diagnosed with TTTS.
- To determine if hemoglobin differences are consistently present in TTTS cases with oligohydramnios-polyhydramnios.
Main Methods:
- Fetal hemoglobin concentration was measured in twins from five monochorionic pregnancies.
- Cases were diagnosed with TTTS based on growth discordance and oligohydramnios-polyhydramnios.
- Hemoglobin levels were compared to gestational norms and between co-twins.
Main Results:
- In three of five TTTS cases, the smaller, oligohydramniotic twin had lower hemoglobin than normal.
- Two of these cases showed a hemoglobin difference greater than 5 g/dl.
- In two cases, all four fetuses with oligohydramnios-polyhydramnios had normal hemoglobin concentrations.
Conclusions:
- Twin-to-twin transfusion syndrome may occur without significant fetal hemoglobin concentration changes.
- Oligohydramnios-polyhydramnios in monochorionic twins can exist in the absence of TTTS or without detectable hemoglobin alterations.