Quintero Staging System

This info was found on this website: http://www.maternal-fetalhealth.com/fetal-therapy/fetal-conditions-treated/twin-twin-transfusion-syndrome/

Diagnosis & Staging of Twin-Twin Transfusion Syndrome (TTTS)

The in utero diagnosis of Twin-Twin Transfusion Syndrome (TTTS) is established by ultrasound. First, the presence of a monochorionic twin gestation should be confirmed. Usually ultrasounds performed earlier in the pregnancy may be useful in establishing the chorionicity (number of placentas). Ultrasound findings such as a single placenta, same fetal sex, and a “T-sign” in which the dividing membrane inserts perpendicular to the placenta are helpful in diagnosing a monochorionic twin gestation.

Twin-Twin Transfusion Syndrome (TTTS) is then diagnosed simply by assessing the discordance of amniotic fluid volume on either side of the dividing fetal membranes. The maximum vertical pocket (MVP) of amniotic fluid volume must be greater than or equal to 8.0 centimeters in the recipient’s sac, and less than or equal to 2.0 centimeters in the donor’s sac.

Once the diagnosis of Twin-Twin Transfusion Syndrome (TTTS) is established, the severity of the condition may be assessed using the Quintero Staging System, as listed below. This staging system is based on the observations of several hundred patients with Twin-Twin Transfusion Syndrome (TTTS). Not only does this staging system mirror the progression of disease, but it has also been shown to be important in establishing the prognosis. An atypical presentation of Twin-Twin Transfusion Syndrome (TTTS) may occur if the fetal bladder of the donor twin remains visible despite the presence of critically abnormal fetal Dopplers or hydrops.

Quintero Staging System

Stage I: The fetal bladder of the donor twin remains visible sonographically.

Stage II: The bladder of the donor twin is collapsed and not visible by ultrasound.

Stage III: Critically abnormal fetal Doppler studies noted. This may include absent or reversed end-diastolic velocity in the umbilical artery, absent or reverse flow in the ductus venosus, or pulsatile flow in the umbilical vein.

Stage IV: Fetal hydrops present.

Stage V: Demise of either twin.

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