Introducing our newest segment - Great Syndromes! Modeled after Erin's PA school course developed to prepare healthcare students for clinical rotations, this segment utilizes real case scenarios to help guide diagnostic and treatment guidelines for patients in the setting of fetal medicine.

This week our case is a 34-year-old G10 P7 who presents at 23 weeks and 4 days with a referring diagnosis of monochorionic diamniotic twin gestation with Stage II twin-twin transfusion syndrome (TTTS). Her placenta is posterior and the maximum vertical pocket (MVP) of the 'recipient' twin sac is 22.0 cm. In this episode we'll discuss some of the following points: 

• Differential diagnoses for polyhydramnios in pregnancy
  • Maternal gestational diabetes
  • Anatomical fetal anomalies
    • Upper GI tract obstructions
      • Esophageal atresia
      • Duodenal atresia
      • Tracheoesophageal fistula (TEF)
    • Arthrogryposis multiplex
• Twin-twin transfusion syndrome causes hypervolemia in the recipient twin and therefore increase urine output
• Post-procedure tocolytic options nifedipine vs. indomethacin
• How placental location affects surgical approach in TTTS