*SPECIAL GUEST* - Dr. Saul Snowise – Part 1 of 2 This week we continue our discussion with Dr. Saul Snowise talking about the role of selective reduction, specifically in the setting of monochorionic twins. This week we'll be covering the following: Dr. Snowise’s preferred tool/method for selective reduction Selective reduction in the setting of monoamniotic twins with discordant anomalies & cord entanglement Various instruments & equipment used for the different methods of s...

*SPECIAL GUEST* - Dr. Saul Snowise – Part 1 of 2 This week and next week we have a two-part series with Dr. Saul Snowise as we discuss the role of selective reduction, specifically in the setting of monochorionic twins. Join us as we discuss the following this week: How selective reduction differs in monochorionic vs. dichorionic twins Most common method of selective reduction Potassium chloride (KCl) injection contraindicated in monochorionic twins Method for monocho...

Welcome back "What they didn't teach you in laser school" – now onto Part 2! This week we’re going to continue talking about all our laser tips & tricks while discussing the following: Anterior placenta challenges Future of steerable operative scopes Current 30 degree operative Storz scope Using external pressure to aid in flattening the uterus Intraoperative amnioinfusion Intraoperative complications Concurrent fetal bradycardia in both fetuses What to do when th...

Welcome to "What they didn't teach you in laser school"! This two-parter is going to be filled with Dr. Moise's tips and tricks (and some of Erin's too) as we share the following topics: Pre-operative evaluation tips Identifying cord insertions via ultrasound Following the lie of the donor twin to find the inter-twin anastomotic plane Not true for “cocoon” sign Re-evaluate and confirm cord insertions and anticipated cannula insertion site in the OR Confirming renal bl...

This week we’re going to be using the most recent episodes as building blocks to discuss atypical presentations of twin-twin transfusion syndrome or TTTS. Dr, Moise takes us through the following ‘unicorn’ presentations by covering the following: Review of the classic Quintero staging system for TTTS Stage I, II, III, IIID, IIIR, IIIDR, IV, V Alternative TTTS staging systems that have been proposed Cincinnati CHOP Case scenario of an atypical TTTS IIID TTTS with sIUGR Revie...

*SPECIAL GUEST* - Dr. Ramesha Papanna – Part 2 of 2 Join us as we continue our discussions on Twin Anemia Polycythemia (TAPS). This week Dr. Papanna walks us through the following topics on TAPS: Society of Maternal Fetal Medicine (SMFM) and International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines and recommendations for monitoring MCA Dopplers in monochorionic twins Laser ablation of placental anastomoses as treatment for TAPS Transabdominal ...

*SPECIAL GUEST* - Dr. Ramesha Papanna – Part 1 of 2 Join us as we head down another aisle of Twins R’ Us but this time with a very special guest who is joining us for this two-part series on Twin Anemia Polycythemia Sequence (TAPS)! This week Dr. Papanna walks us through the following topics on TAPS: Defining TAPS Pathophysiology of TAPS Difference between spontaneous TAPS and TAPS after a laser for TTTS How TAPS is detected Rate of occurrence of TAPS in monoc...

We know many of you tuned in eager to hear a big clinical research update that we've been so excited to share! That episode will be coming down the pipeline soon but unfortunately will not be released today. Stay tuned for an episode later today as we travel down the TAPS aisle of Twins R' Us with Dr. Ramesh Papanna!

We're heading down the Taco Aisle at Twins R' Us this week as we dive into sIUGR also known as selective intrauterine growth restriction. Join us this week as we discuss the following: Defining sIUGR in monochorionic twins Must meet at least two of the following four criteria Smaller twin must be less than 10th percentile for EFW by ultrasound And/Or the smaller twin’s AC must be less than 10th percentile for gestational age More than 25% difference of smaller twin and the bigger t...

Introducing our newest segment - Great Syndromes! Modeled after Erin's PA school course developed to prepare healthcare students for clinical rotations, this segment utilizes real case scenarios to help guide diagnostic and treatment guidelines for patients in the setting of fetal medicine. This week our case is a 34-year-old G10 P7 who presents at 23 weeks and 4 days with a referring diagnosis of monochorionic diamniotic twin gestation with Stage II twin-twin transfusion syndrome (TTTS). He...

*SPECIAL GUEST* - Dr. Yves Ville – Part 2 of 2 This is an episode we recorded at the 2023 SMFM Conference back in February. Our special guest, Dr. Yves Ville, returns this week to continue our discussion about his role and contributions to the field of fetal surgery and specifically twin-twin transfusion syndrome. In part 2 we go through the following: Outcomes on survivors of both fetuses, one fetus or loss of both fetuses Laser surgery becomes accepted as evidence-based treatment a...

*SPECIAL GUEST* - Dr. Yves Ville – Part 1 of 2 This is an episode we recorded at the 2023 SMFM Conference back in February. Our special guest this week, Dr. Yves Ville, sat down with us to talk about his role and contributions to the field of fetal surgery and specifically twin-twin transfusion syndrome. In part 1 we go through the following: Dr. Ville’s training and the events that led up to him entering the field of fetal medicine Dr. Ville’s experience with laser surgery for twi...

*SPECIAL GUEST* - Dr. Michael Bebbington. This week Dr. Bebbington joins us to talk about the background of twin-twin transfusion syndrome (TTTS) as he covers the following topics: Pathophysiology of twin-twin transfusion syndrome (TTTS) ‘Donor’ twin vs. ‘Recipient’ twin Types of vessel anastomoses involved in TTTS AA – artery to artery VV – vein to vein AV – artery to vein VA – vein to artery Pathophysiology of the polyhydramnios and oligohydramnios seen in TTTS Assessing Dopplers i...

We’re talking through the season six premiere of The Resident, where they take on a twin-twin transfusion case. We debunk and verify all myths and truths depicted in this episode surrounding the counseling, diagnosis, management, and even laser surgery itself from this episode.

This episode is dedicated to the late Dr. Julian De Lia whom we lost in November 2022. Dr. De Lia was truly one of the greatest fetal surgery pioneers, particularly in the TTTS. Welcome back to Twins R Us! This week we’re going to talk about the history of twin-twin transfusion syndrome (TTTS) and the history of treatment for the disease. Dr. Moise will take us through the following topics in this episode: The discovery of pathophysiology of TTTS Idea of the ‘Third Circulation’ Berniske’...

We’re back on scheduled wombmates! This week we’re talking about management of twin pregnancies as Dr. Moise takes us through the following topics: The role of ultrasound in twin pregnancies CRL = Crown Rump Length for dating Chorionicity determination Transvaginal cervical length measurement Importance of the 18-20 week anatomy scan and fetal echocardiogram Ultrasound monitoring based on chorionicity Dichorionic pregnancies should be followed every 3 to 4 weeks with a growth scan ultra...

We're kicking off a new series on all things twins! Welcome to Twin 'R' Us where we will introduce the following in this episode: Prevalence & rate of occurrence of twins in general and the different types The different types in twins in terms of zygosity Identical – monozygotic Fraternal – dizygotic Rare fraternal twin occurrences: Superfetation Heteropaternal superfecundation Factors that affect a women’s risk of twinning Monozygotic – chance of nature Dizygotic Genetic...

No new episode today wombmates! We've had a busy clinic the last couple of weeks and Erin is heading out on vacation, but stay tuned for new content to drop later in the week!

Before we enter our next series on twins, we wanted to go give some background on fetal centers and what they are. In this episode we’ll discuss some basic background on fetal centers, fetal therapies, and fetal medicine by covering the following: Types of cases seen at a fetal center: 70% anomalies with coordination of care 20% fetal surgery or fetal intervention 10% life-limiting anomalies As of early 2023 there are currently about 37 fetal centers in the United States Of which...

*SPECIAL GUEST* - Dr. Jacqueline Vidosh In honor of Edwards Syndrome Awareness Day, March 18th, we're dropping Part 2 of our interview with Dr. Vidosh a little bit early. Dr. Vidosh is a practicing OBGYN and proud Mother of a baby boy, Noah, diagnosed with Edwards Syndrome. This week she talks a bit more about Noah's early life and childhood as she continues her story. Resources: Support Organization For Trisomy (SOFT) Trisomy 18 Foundation