Stage
|
Parameter
|
Criteria
|
1
|
MVP of amniotic fluid
|
MVP<2cm in donor and MVP>8cm in recipient
|
2
|
Fetal bladder
|
Fetal bladder in donor twin is not visualized over
60min observation
|
3
|
Doppler waveforms:
|
At least one of these 3 abnormalities:
|
a-umbilical
artery
|
Absent
or reversed diastolic flow.
|
|
b-ductus
venosus
|
Reversed
a-wave flow.
|
|
c-umbilical
vein
|
Pulsatile
umbilical vein flow.
|
|
4
|
Fetal hydrops
|
Hydrops in one or both twins
|
5
|
Fetal cardiac activity
|
Absent cardiac activity – fetal demise in one or
both twins.
|
Quintero system classified the disease into 5 stages based on the
ultrasound findings. 5 parameters are assessed to stage the disease. The
parameters include: 1) maximum vertical pocket (MVP) of amniotic fluid,
2) fetal bladder, 3)Dopplers abnormalities of the umbilical artery or
ductus venosus, or umbilical vein, 4)fetal hydrops and 5)fetal cardiac
activity.
Stage 1 disease occurs when the is only discordance in the amniotic fluid volume, the 1st criteria, which is detected by comparing the measurement of the maximum vertical pocket of the amniotic fluid in each amniotic sac of the donor twin and the recipient twin, with the absence of the other 4 criteria. When maximum vertical pocket of the amniotic fluid in donor sac less than 2cm and maximum vertical pocket of the amniotic fluid in recipient sac is more than 8cm, the disease is at least at stage 1.
Stage 1 disease occurs when the is only discordance in the amniotic fluid volume, the 1st criteria, which is detected by comparing the measurement of the maximum vertical pocket of the amniotic fluid in each amniotic sac of the donor twin and the recipient twin, with the absence of the other 4 criteria. When maximum vertical pocket of the amniotic fluid in donor sac less than 2cm and maximum vertical pocket of the amniotic fluid in recipient sac is more than 8cm, the disease is at least at stage 1.
The presence of 2nd criteria that is
non-visualization of donor twin bladder indicates at least stage 2. The
disease is at least stage 3 when there is presence of the 3rd criteria
that is the presence of any of these dopplers abnormalities: 1) absent
or reversed diastolic flow of the umbilical artery, 2) reversed of
a-wave flow of the ductus venosus or 3)pulsatile flow of the umbilical
vein. Fetal hydrops (4th criteria) indicates at least stage 4 and when
there is fetal demise (5th criteria) the disease already at stage 5.
-Maximum vertical pocket measurement- |
-umbilical artery, ductus venosus and umbilical vein shown- |
hydrops - ascites, pleural effusion and scalp edema shown- |
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