what exactly determines TTTS is "official"?

my ID boys are monochorionic, so they're monitoring for TTTS, and so far everything looks good. but at my last U/S they were 11 ounces apart, and b-4 that they've never been more than 2 ounces different. so I'm wondering if this could be the beginning of TTTS, but not yet a concern because it's still a farly small difference? or if there are other things that they look for to indicate TTTS as well? I'm just concerned that it's possible that they could end up with an even bigger difference at my next U/S. but when is it time for concern, and when is it no big deal? the Dr wasn't concerned at all yet. but to go from less than an ounce in size difference to 11 ounces concerns me a little.

anyone know what specifically they look for? is it a % difference in weight? fluid levels? blod flow?

all I've ever heard is size difference, so I'm really not sure what should concern me.
thanks
Michelle

 

my ID boys are monochorionic, so they're monitoring for TTTS, and so far everything looks good. but at my last U/S they were 11 ounces apart, and b-4 that they've never been more than 2 ounces different. so I'm wondering if this could be the beginning of TTTS, but not yet a concern because it's still a farly small difference? or if there are other things that they look for to indicate TTTS as well? I'm just concerned that it's possible that they could end up with an even bigger difference at my next U/S. but when is it time for concern, and when is it no big deal? the Dr wasn't concerned at all yet. but to go from less than an ounce in size difference to 11 ounces concerns me a little.

anyone know what specifically they look for? is it a % difference in weight? fluid levels? blod flow?

all I've ever heard is size difference, so I'm really not sure what should concern me.
thanks
Michelle

 

I can't think of all the specifics off the top of my head. As far as fluid levels, one baby has to have a level of 8 or more while the other has to have less than 2. I think fluid levels are a better way of determining it than weight differences. Or both together, of course. A difference in weight more than 20% is cause for concern, but doesn't necessarily mean TTTS. There could be IUGR issues that don't include TTTS. Did they do a doppler flow check on the babies? That would be important as well. With TTTS, usually the donor's bladder is very small or can't be seen at all while the recipient's is usually very large. It's great that you are already almost 32 weeks! There's more info in the Health Issues forum or at tttsfoundation.org. I also wanted to say...at the stage you're at, ultrasound measurements aren't necessarily as accurate as they once were...since the babies are so squished in there. Hope this helps some.

 

Raneysmama is correct.

I was diagnosed by my peri with TTTS at 21 weeks based on cord blood flow issues (absent reverse-end diastolic velocity) and the difference in fluid levels. By the time I got to Dr. Quintero in Florida for the surgery to correct it (just a few days later) the fluid levels were way more normal so I didn't have to have the surgery. Dr. Q stressed that it is diagnosed solely on the fluid levels now, NOT size discordance. The deepest pocked of fluid on one baby has to have more than 8cm and the deepest on the donor baby less than 2cm. My "donor" baby had just over 2 and once I got to Dr. Quintero, he was up to like 4+. In addition to the fluid, they look for the cord blood flow problems - so make sure your peri is doing doppler studies on the cords as well as checking the fluid levels.

My twins are still discordant in weight - 25% - but it is a matter of IUGR for one baby, not TTTS.

Go to www.tttsfoundation.org or google "Dr. Quintero / TTTS" for more info.

 

thanks for the replies. the fluid for both is looking good still. so it looks like there's really nothing to worry about. I still find it odd that they had such a big jump in size difference. but I guess so long as they both grow, and the difference doesn't get too big I'll not loose sleep over it (there are so many other things to loos sleep over, like back pain! hehe).

thanks again!
Michelle

 

One of our former mods here on TS has written a great info thread on TTTS in the Health Issues forum. You can find it here when you have some time!