Twin-to-twin transfusion syndrome: A subset of the twin oligohydramnios-polyhydramnios sequence

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Our purpose was to assess the adequacy of currently accepted criteria for the diagnosis of twin-to-twin transfusion syndrome. Between April 1991 and February 1992 nine consecutive women with twin gestations and ultrasonographic findings of marked growth discordance, coexistent oligohydramnios-polyhydramnios, monochorionic placenta, and same sex of the fetus in the second trimester were evaluated. Mean gestational age at diagnosis was 19 weeks 5 days +/- 5 weeks, and mean growth discordance was 34% +/- 9%. Seven women underwent attempted sequential amniocentesis and cordocentesis at 23 weeks 6 days +/- 2 weeks 4 days to obtain amniotic fluid and cord blood from each fetus. Type O negative, leucocyte-poor, washed adult red blood cells were transfused into the small, oligohydramnic twin during cordocentesis; immediately afterward blood from the polyhydramnic twin was tested with the Kleihauer-Betke stain. The combined procedure was successful in six (86%) of the cases attempted. True twin-to-twin transfusion was confirmed in only four (44%) of those initially identified by ultrasonographic criteria. Hemoglobin difference > 5 g/dl was present in only one of the four cases, and in this case the recipient was anemic. Currently accepted criteria are insufficient for the diagnosis of true twin-to-twin transfusion. Ultrasonographic findings of marked growth discordance, coexistent oligohydramnios-polyhydramnios, monochorionic placenta, and same sex identify the twin oligohydramnios-polyhydramnios sequence.