Twin-to-Twin Transfusion Syndrome: Diagnostic Imaging and Its Role in Staving Off Malpractice Charges and Litigation

Abstract

The study aims to expound upon the imaging-based diagnostic methodologies aimed at identifying twin-to-twin transfusion syndrome (TTTS), a serious, somewhat rare prenatal condition that takes place in pregnancies where identical twins, or other multiples, share a placenta (monochorionic placenta), highlighting how medico-legal outcomes can be affected by provable compliance with consolidated diagnostic guidelines or best practices. It is of utmost importance to produce a prompt identification of TTTS instances; an early diagnosis is in fact critical in order to effectively treat and manage TTTS. By virtue of TTTS being a highly progressive condition, a delay in diagnosis can result in disastrous outcomes; just a few weeks delay in the diagnosis of TTTS can turn out fatal for one or both twins. Hence, most TTTS malpractice claims involve allegations of medical negligence, namely the failure to recognize the condition in a timely fashion, or to proceed with adequate diagnostic and therapeutic pathways. In that regard, case law databases have been pored over (Justia, Lexis, Leagle), and five significant court cases have been examined and discussed in an attempt to identify objective medico-legal standards and bring to the forefront relevant forensic dynamics. In fact, when health professionals are capable of proving adherence to guidelines or best practices, this can shield them from malpractice allegations and ensuing litigation.

Predictive values of first trimester ultrasound screening for twin-to-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic twin pregnancies

“…The sonographic manifestations usually may be noted as early as 16 weeks of gestation, but they can appear in the third trimester as well. TTTS manifestations are rare after 28 weeks of gestation (Zaami et al, 2021). Despite the hypervolemia, vascular resistance in the recipient twin is increased.…”

Doppler Finding, Cardiovascular Function Assessment, and Fetuses’ Survival Following the Fetoscopic Laser in Twin-to-Twin Transfusion Syndrome

“…4 In this regard, current guidelines strongly recommend serial sonography beginning in the first trimester and every 2 weeks from 16 weeks of gestation until 26 weeks as screening in monochorionic diamniotic twin pregnancies for the early detection of TTTS. 5,6 Ultrasound is the gold standard tool for the early detection of TTTS by tracking volume overload and polyuria followed by polyhydramnios in one twin and, paradoxically, oliguria followed by oligohydramnios in another twin. 7 For staging the severity of this phenomenon, the assessment of arterial and venous Doppler patterns along with bladder filling is very helpful.…”

Retrospective validation of ultrasound characteristics at 19–24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies: a diagnostic study

“…Ultrasound examination serves as a routine method for predicting sIUGR. Previous studies have shown that the evaluation of utero-placental perfusion indices, including umbilical artery and middle cerebral artery velocimetry using Doppler ultrasound, have good efficacy for sIUGR prediction (9)(10)(11)(12)(13)(14). Additionally, magnetic resonance imaging (MRI) of placental invasion has recently become part of clinical practice (15); however, the major disadvantages of MRI include expensive devices and relatively complex techniques.…”