Twin-To-Laser Test

Conjoined twins are a rare phenomenon. In the even that a set should appear where one twin is dependant upon the other, I believe that they should be separated, at minimum, to save the life of one. At the same time, I believe that every set of conjoined twins is its own special case. In this study, I will present the background information on conjoined twinning, give a few case studies, and give the pros and cons of conjoined twin separation. I will end with my own views on the subject.

Twin-to-twin transfusion syndrome (TTTS) is a rare disease occurring in 10-15% of monochorionic-diamniotic twin gestations in which vascular connections are shared between the fetuses via a common placenta1, 2, 3. A theoretical imbalance in the vascular distribution creates a shift in circulation causing one fetus to receive a surplus in volume, the recipient, and the other to be deficient, the donor4, 5. TTTS can present at any gestational age6 and can progress in severity causing significant morbidity, especially to the recipient, and even demise of one or both twins1, 2, 6. Classic ultrasonic markers of TTTS have been well-described as an amniotic fluid imbalance between the twins2. Several staging systems have been

efforts to restrict its use. Some believe that advances in medical technology have contributed to its overuse.Two of the primary issues that arise with the treatment include whether or not it is “necessary” in certain cases and whose safety needs to be taken as a priority, especially in a case of twins. With a breakthrough this big that has the power to save children from innumerable

The most common treatment for SCID is bone marrow transplantation, which has been successful using either a matched related or unrelated donor, or a half-matched donor, who would be either parent. Today, transplants done in the first three months of life have a high success rate. Physicians have also had some success with in utero transplants done before the child is born and also by using cord blood which is rich in stem cells. In utero transplants allow for the fetus to develop a functional immune system in the sterile environment of the uterus. More recently gene therapy has been attempted as an alternative to the bone marrow

On ultrasound there is a live fetus in cephalic presentation. Fetal biometry is consistent with dates. A limited survey was unremarkable. Fluid and Doppler’s are overall reassuring and BPP is 8/8.

Conjoined twins are identical twins whose bodies are joined in utero. The occurrence is estimated to range from 1 in 50,000 to 1 in 100,000 births, with a somewhat higher occurrence in Southwest Asia and Africa. [1] The condition is more frequently found among females, with a ratio of 3:1. [2] Many are born with abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 20%. [3]

Twin girls were born in the East African country with a fatal condition. These twins were conjoined. In the African society, this condition was viewed as disgraceful, making it harder for the parents to seek medical treatment. So, In mid-2016 the 22-month-old twins, that were conjoined at the abdomen and pelvis, came to the U.S. for treatment. According to the article "An Ethical Dilemma In A Case Of Conjoined Twins From East Africa" it says "Doctors determined that Twin A, as the paper calls her, suffered from congenital heart disease. Doctors believed she would die with or without the separation surgery. And they further believed that if the twins were not separated and Twin A were to die, Twin B would die soon after because of shared blood

Evaluating amniotic fluid is an essential component of any obstetric ultrasound exam. It is especially important in twin pregnancies, as they can be difficult and complex to begin with. This article describes a potential pitfall, the amniotic wrinkle, which can lead to the erroneous impression that both twins have adequate fluid when one actually has oligohydramnios. The intrauterine sling or cocoon sign is also discussed, which, with the amniotic wrinkle, has been linked to twin-twin transfusion syndrome.

October 2000 - A child conceived in part to provide therapeutic tissues for an earlier-born sibling is born; techniques of preimplantation genetic diagnosis are used to ensure that the child does not itself carry the disease

According to Pinborg of 2005, Since the 1970s, the national twin birth rates have been increasing worldwide. Apart from the increasing childbearing age, the main cause is the use of assisted reproductive technologies (ART). To explore the overall consequences of dual embryo transfer (DET), the literature has been reviewed systematically regarding short- and long-term outcomes of IVF/ICSI twin pregnancies i.e. pregnancy complications, maternal risks, obstetric outcome and long-term morbidity including neurological sequelae, cognitive development and family implications. Another consequence of DET is vanishing twins, which seems to be a possible cause of adverse outcome in IVF singletons. The sparse literature on vanishing twins in IVF pregnancies

Patient Z is a 36 year-old female, having a spontaneous preterm vaginal birth with a set of dizygotic twins at 26 + 1 weeks. The babies were conceived through the use of in vitro fertilization, this process of fertilization occurs outside of the woman’s body. It is where the woman’s eggs are removed and artificially fertilized with the father’s sperm then implanted back into the woman’s womb as an embryo (FFF). The chances of twins are increased when going through the process of in vitro fertilization.

The fetoscopic laser therapy [17] is currently recognized as the first-line treatment for stage I to IV TTTS diagnosed before 26 weeks of gestation, resulting in better survival and neurological outcomes of fetuses. However, because laser therapy has to coagulate the placental anastomotic vessels between the two fetuses in TTTS, the decreased placental perfusion to the donor twin with FGR may cause a higher fetal demise rate than in the TTTS donor without FGR [18]. Furthermore, the procedure of laser therapy is not free of complications. In our series, 11.4% of treated cases experienced premature rupture of membranes (PROMs) within 3 weeks, and 2.2% of treated cases developed chorioamnionitis needing termination [11]. So in the TTTS twins

Intrauterine stem cell therapy (IUSCT) refers to treatment of a variety of fetal genetic disorders thought transplantation of either allogenic or genetically modified autologous stem cells. Stem cells become incorporated into the recipient tissue to start proliferation and differentiation through their pluripotent or multipotent potential to compensate for the missing or defective protein. This could be useful in treating fetal genetic disorders which are considered to be perinatally lethal or associated with significant disability and morbidity if intervention is delayed to postnatal period (1).

The principal mode of diagnosis is a differential diagnosis, and it includes a plethora of facets; bleeding from implantation site, which may be due to uterine atony, with predisposing factors such as infections, and retained placenta or abnormal placentation (Sheiner, 2011). Coagulation disorders and trauma are also essential facets considered during diagnosis (Sheiner, 2011). Conventionally, there are different methods used for the estimation of blood loss during diagnosis, and they are majorly classified as clinical and quantitative methods (Ricci & Kyle, 2009). Clinical method remains the primary means to

The difference between a uterus and other organs that are transplanted is that a uterus is not a vital organ, so the surgery is therefore declared purely a “quality of life procedure”. Since the surgery isn’t life-sustaining, the use of live donors is not only possible but encouraged by many experts as it has produced the most positive results over the usage of deceased donors. With the cases that have used live donors, it is often preferred that the donor be immediately related to the recipient- mother or sister. The first mother- daughter uterine transplant was a part of the 2013 Swedish clinical trials and the patient has managed to give birth post-operation. The donor surgery lasted 10 hours and 17 minutes, noted a blood loss volume of 400 mL, and required a 6 day hospital stay. Despite the prolonged retrieval time, the operation has had no lasting psychological or physical effects on the donor. The recipient surgery required less than half the time, lasting only 4 hours and 44 minutes. She had a blood loss of 300 mL and a hospital stay of 7 days. (Niederberger) The issue with live donor transplants is the question of whether the procedure is worth the harm to the donor when an alternative is possible. It should also be noted that a higher percentage of the uteruses transplanted from deceased donors have tended to be necrotic than those from live donors. However, with the number of transplants performed being so scarce, it is hard to determine whether there is a connection between the two.