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TTTS - Growth Discordance Question

rinascitarinascita member
in Multiples

So, I've read a few different posts about TTTS and the frequency of monitoring being provided by MFM's.

When should you be concerned or ask for more frequent scans?

At my 17w,1d scan the growth discordance was 5% with Baby A measuring 18w,0d and avg. 79th percentile, Baby B measuring 17w,3d and avg. 57th percentile.

They told me they would be concerned if the growth discordance gets to 20%+ but I wasn't sure when advanced monitoring should begin vs. when interventions/procedures come into play for TTTS.  For example, what does 20% indicate, only increased monitoring or a diagnosis of TTTS with intervention needed?

TIA for any insight!! 

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Re: TTTS - Growth Discordance Question

  • pixiem38pixiem38 member
    I am fairly certain.i.just read something that addresses your questions. I am going to.look and see if i can find it.
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  • rinascitarinascita member

    imagepixiem38:
    I am fairly certain.i.just read something that addresses your questions. I am going to.look and see if i can find it.

    I tried flipping through my stack of multiples books, but I guess I should've never neglected my old friend Google...

    https://www.tttsfoundation.org/faq.php

    I'm not sure it fully answers my question, but it discusses the 20% threshold. 

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  • pixiem38pixiem38 member
    Of course now that i am.looking i can't find it. I think the diagnoses has more to do with the fluid levels and the bladder (and then blood flow.with doppler) than just the discordance. i am thinking that the discordance triggers them to.look for the rest and monitor closer...but i very well may be wrong. I got a lot of.good.info.going to the different hospitals websites that actually treat ttts...they had informational brochures and videos.and whatnot (and the hospitals were listed on ttts foundation webpage)????????????????????? google.is.very scary?????but the ttts foundation.page is pretty useful. Good luck....i hope they monitor you lots.and that it is nothing.
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  • erinrunserinruns member

    Here's an article that talks about the various stages of TTTS - https://en.wikipedia.org/wiki/Twin-to-twin_transfusion_syndrome

    I had an u/s at 18 weeks where there was a 20+% growth discordance *and* my fluid levels were borderline on both ends (2.5 & 7.4).  The plan at the time was to intervene when both fluid levels went out of bounds, until then they would just monitor me more closely.  Two weeks later they did go out of bounds and they did an amniotic reduction to help bring the fluid levels back in line.  Had that not worked, we would have pursued laser surgery.  

    A 5% growth discordance likely won't mean any more monitoring than they would do normally for identical twins.  They still need to keep a close eye on you, but there are definite data points that come into play as to when they intervene.   

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  • Mrs. AliceMrs. Alice member
    imagerinascita:

    imagepixiem38:
    I am fairly certain.i.just read something that addresses your questions. I am going to.look and see if i can find it.

    I tried flipping through my stack of multiples books, but I guess I should've never neglected my old friend Google...

    https://www.tttsfoundation.org/faq.php

    I'm not sure it fully answers my question, but it discusses the 20% threshold. 

    The foundation is a good site for resources.  Just keep in mind that growth discordance doesn't always equal TTTS.  Sometimes mono/di twins can have selective IUGR without TTTS.  Once my boys were diagnosed TTTS we went weekly for u/s then I was admitted at 24 weeks until delivery.  In my case we weren't candidates for surgery but were able to far enough along to deliver.  I wouldn't be concerned about 5%, that sounds like within normal range.  I would push for u/s every 2 weeks regardless.

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  • MrsJeffsWife2BMrsJeffsWife2B
    My twins have been more than 20% for months now, and all they did was make sure I came in every 2 weeks for growth scans to "keep an eye on it". The gap has closed a little recently but still is there. I only started to need to go weekly when my OBs reqeusted that the MFM do weekly NSTs. My fluid levels have always been find and my girls are di/di so that could factor in!
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