Have you read about twins. 1 normal, 1 very small?

suzy253, RN · Feb 25, 2004

Is it Twin-to-Twin Transfusion? Not really sure cos I'm 'just a student' :)

kwagner_51 · Feb 25, 2004

I don't know!! From what I got from my daughter, the gestation was 7 months. One of the twins was normal size for being preterm. The other one was the size of a coke can. According to my dd, the baby was perfectly formed heart and lungs working. From what she remembers, they were conceeived at the same time. I was wondering if maybe it was SUPERFETATION. This is where conception took place at different times.

Have any of you seen this?

punim1974 · Feb 25, 2004

sounds like twin transfusion syndrome (if it's not superfecundation, which according to my understanding, is much less common), to me, but since i know relatively little about ob by comparison to the nurses on here, i couldn't be positive with that.

rpbear · Feb 25, 2004

Twin to twin transfusion is where one twin gets normal or high amounts of blood and the other gets low amounts of blood from the placenta. This is very dangerous to both babies. I don't know all the specifics but that is the basics, maybe someone else could explain more.

kwagner_51 · Feb 25, 2004

Here is one article about this:

Texas Woman Gives Birth to 12-Ounce Baby

HOUSTON (Feb. 20) - A Texas couple has given birth to twin girls, including one who is one of the tiniest babies ever delivered. Dodie and Vaughn Walpole's daughters were born on Feb. 11, about two months premature. Trinity weighed 2.8 pounds at birth, and Kylie was 12 ounces.

"She will fit in the palm of your hand - my husband's wedding ring fits over her arm and her leg," Dodie Walpole said of Kylie. "She's a fighter. It's amazing."

Despite their size, Kylie and her sister are doing well.

Though most infants born at that weight and size typically need help breathing, neither baby required a respirator.

"Everything is developed," said Dr. Rose Hernandez, a neonatologist who is treating the girls at the Woman's Hospital of Texas in Houston. "Her brain is fine, her lungs are fine, her kidney is fine, her heart is fine, everything is perfect."

The couple live in Tomball, northwest of Houston. After a decade of being unable to conceive, Dodie Walpole sought help from a fertility specialist. Now that they have two healthy girls, the couple is satisfied they probably won't have more.

"Two is enough," Dodie Walpole told the Houston Chronicle for a Friday story.

02/20/04 12:44 EST

So....Any Ideas?

prmenrs, RN · Feb 25, 2004

Sometimes it's called discordant twins. Twin-twin transfusion can be very dangerous for both babies--the smaller one is very anemic and can even be brain damaged from that, the bigger one has a crit of 80 sometimes, basically sludge trying to circulate and not doing it well.

fergus51 · Feb 25, 2004

We use the term discordant growth. It is not the same as twin to twin transfusions. It's just that one twin doesn't grow properly. Can be caused by placental insufficiency or genetic anomolies from what I understand.

fergus51 · Feb 25, 2004

Here's a good little explanation

http://www.findarticles.com/cf_dls/m0CYD/9_36/75505224/p2/article.jhtml?term=

New Approach to Risk Assessment in Twins.

OB/GYN News, May 1, 2001, by Bruce JancinContinued from page 1

Discordant growth, defined as at least a 20% difference in fetal weight, occurs in 15%-30% of twins. Textbooks state that this is a serious cause for concern. But a recent University of Colorado study of 102 twin pregnancies suggests the situation isn't so black and white.

The study showed, surprisingly, that the only patients who got into trouble were those with discordant growth in which one fetus was small for gestarional age (SGA), and the other wasn't. They delivered at a mean of 33.75 weeks' gestation, compared with 36.5 weeks for the overall group. Again, the subgroup with two SGA fetuses actually had the greatest gestational age of all at delivery.

With length of stay in the neonatal nursery as a proxy for health status at delivery, it was interesting to note that SGA babies from discordant-growth pregnancies had an average stay of 25 days, while SGA babies from pregnancies in which both babies were SGA stayed only one-quarter as long, Dr. Hobbins continued.

In another Colorado study, 24 women with growth-discordant twin pregnancies underwent serial ultrasound evaluation. Those in whom the discordance was detected before 30 weeks delivered at a mean gestational age of 33.4 weeks, compared with 35.5 weeks when growth discordance showed up only later in pregnancy Small babies with early growth discordance stayed a mean of 40 days in the newborn nursery compared with 19 days for those who showed growth discordance only after 30 weeks.

Early growth discordance was typically associated with a substantially less lush placenta on the side of the smaller twin. These fetuses also demonstrate significantly lower average and peak blood flows through the umbilical vein, according to Doppler ultrasound studies by Dr. Hobbins and coinvestigators at the University of Milan.

"One twin is in trouble, the other is an innocent bystander. It raises an ethical question sometimes of when to deliver," he said.

The underlying idea behind this early ultrasound assessment is that when physicians see these abnormalities, they can intensify their surveillance in an effort to precisely time delivery to diminish the chance of neurologic sequeli, he explained.

"The more we look at this, the more it looks like the converse is true," Dr. Hobbins added. "If you don't have a short cervix, if you don't have twin-to-twin discordance early on, and if the placentas look equally lush, you're going to be able to leave these people alone and just let them have a nice pregnancy instead of what we wind up doing now, which is just studying the heck out of them."

crankyasanoldma · Feb 25, 2004

I'm not sure exactly why that made the news- it's not the smallest baby ever delivered. Perhaps it is the oldest and smallest or the twin situation.