Multiple pregnancy: twin-twin transfusion syndrome: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Multiple pregnancy: twin-twin transfusion syndrome

Sample item

A monochorionic diamniotic twin pregnancy at 20 weeks shows a donor twin with oligohydramnios and no visible bladder, and a recipient twin with polyhydramnios and a large bladder. Doppler studies are normal. What is the Quintero stage and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Stage II; fetoscopic laser coagulation of the placental anastomoses

The Quintero staging system grades TTTS: stage I has oligohydramnios and polyhydramnios with a visible donor bladder, stage II has a non-visualised donor bladder, stage III has abnormal Doppler, stage IV hydrops and stage V fetal demise. Stage II or more between 16 and 26 weeks is treated with fetoscopic laser ablation of the connecting vessels. Amnioreduction is an alternative.

Option by option

  • A. Stage II; fetoscopic laser coagulation of the placental anastomoses (correct)

    Correct. A non-visible donor bladder with normal Doppler is stage II, and laser ablation is the treatment.

  • B. Stage I; weekly observation only

    Stage I still has a visible donor bladder.

  • C. Stage III; immediate delivery

    Stage III requires abnormal umbilical artery, ductus venosus or vein Doppler.

  • D. Stage V; selective reduction

    Stage V is demise of one or both twins.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Stage II; fetoscopic laser coagulation of the placental anastomoses. The Quintero staging system grades TTTS: stage I has oligohydramnios and polyhydramnios with a visible donor bladder, stage II has a non-visualised donor bladder, stage III has abnormal Doppler, stage IV hydrops and stage V fetal demise.

Why is "Stage I; weekly observation only" not the answer?

Stage I still has a visible donor bladder.

Why is "Stage III; immediate delivery" not the answer?

Stage III requires abnormal umbilical artery, ductus venosus or vein Doppler.

Why is "Stage V; selective reduction" not the answer?

Stage V is demise of one or both twins.

What concept does this question test?

It tests Multiple pregnancy: twin-twin transfusion syndrome in OBG. Stage II or more between 16 and 26 weeks is treated with fetoscopic laser ablation of the connecting vessels. Amnioreduction is an alternative.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Multiple pregnancy: twin-twin transfusion syndrome?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.