When While Donor Twin is low on fluid, yet still has some showing on Sono assessment, there is some chance of Self Resolution. Many will utilize high protein supplementation on the order of 100 to 175 grams daily. The best way to achieve this is through using Unflavored Whey powder added to whatever Mom is eating. Soy can be substituted. There is Obsolete information involving Boost or other prepackaged supplemental drinks, however we feel that due to they sky high incidence of Gestational Diabetes GD in MoDi that this is best avoided due to the high glucose content of these prepackaged supplements. Expectant Management with Very Frequent monitoring must be used in conjunction with a Stage One TTTS diagnosis, under No circumstance should there be more than Seventy Two (72) Hours elapsed between fluids checks once TTTS Stage One is confirmed. Inpatient with daily monitoring until the case can be shown to have a Margin of Stability with unchanging fluid levels is preferred, with the 72 hours surveillance interval being honored for at least 3 weeks after mom is released. There is a piece of misinformation that is widespread that states ” over 80% of stage one TTTS cases either remain stable or regress…” This is from an old study that Included SIUGR cases Misdiagnosed. The statistic is actually backwards, over 80% of Stage One cases Progress & Worsen.
Comprehensive surveillance of the Stage One TTTS case coupled with review of it by the Laser Centre while still in stage One is a Key to significant reductions in Mortality. Relief of Maternal discomfiture via Therapeutic Amniocentesis is permitted, this also can protect the Amnion from disruption due to polyhydramnios. Extreme Care must be taken so as not to Befoul the amniotic fluid, such as an errant Centesis needle striking a uterine or placental vessel, as this can take Laser off the table, due to fluid Turbidity.

Stage Two & higher stages of TTTS are considered to be in a Dire state, with Laser intervention or the more destructive ones needed immediately if there is to be any hope of salvaging the gestation. The strategies enumerated earlier are useless once there is a Stuck Twin. Again, the progression of TTTS Stage Two & above is Non Linear & any case with a Stuck Twin is considered to be in Imminent Danger.

Michael, thank you so much for explaining the Quintero Stages. We are working on an article that’ll be published next weeks in regards to this – hope you’ll read and comment on that as well, if you have additional information. Thanks again.