Oregon Medical Malpractice For the Failure to Diagnose Twin Transfusion Syndrome in Oregon
Most parents anxiously await the day their baby will be born. For some parents, that feeling is doubled when they are expecting more than one baby. While twins or other multiples are abundant blessings, pregnancies with multiples do carry added risks. While many twin pregnancies progress without incident. There are times when complications occur. For multiples, there are certain unique complications that occur only in the setting of a multiple pregnancy, such as twin to twin transfusion syndrome (TTTS). The failure to diagnose twin transfusion syndrome could be medical malpractice in Oregon.
This rare syndrome occurs in cases of identical multiples where the placenta is shared. This can be very dangerous for one or more of the babies, making it vital for physicians to detect this complication and address as appropriate. When a physician or other healthcare provider fails to identify TTTS, this can lead to serious consequences for the babies that are affected by this syndrome. All medical providers must competently guard against this.
What is Twin to Twin Transfusion Syndrome?
TTTS is also referred to as chronic inter-twin transfusion syndrome. It occurs in 10-15% of identical multiples, or monochorionic twin pregnancies. The placenta is shared in these pregnancies, causing the babies to have to share the oxygen and nutrients from the single placenta. In fraternal twin pregnancies, each twin has it’s own separate placenta, so twin-to-twin-transfusion syndrome does not occur. The failure to diagnose twin transfusion syndrome could be very serious.
TTTS occurs when the umbilical cords for each baby attach too closely, causing the blood vessels of the two cords to become connected inside the placenta. The abnormal connection between the bloods vessels results in TTTs, as it does not allow an even distribution of blood flow for each baby.
Affects of TTTS
It is essential that each baby receives adequate blood supply for fetal development and survival. Unfortunately, in cases of TTTS, one baby receives too much blood while the other does not get enough blood. This has a negative impact on each baby, especially for the baby not receiving enough blood. As a result, the baby who is not receiving enough blood can have complications such as organ failure due to a lack of blood to these vital organs. Additional risks include death as well as brain damage.
The Importance of Amniotic Fluid Levels for Babies with TTTS
For the donor twin, the baby experiences a low amniotic fluid level due to lack of urine produced. The donor twin can have compromise of their kidneys, leading to a reduction in urine production. Low amniotic fluid levels can create a number of complications. For the recipient twin, they experience an amniotic fluid level that is too high (oligohydramnios) due to overproduction of urine, leading to an increased risk for many complications. The failure to diagnose twin transfusion syndrome could be very serious.
How is Twin to Twin Transfusion Syndrome Diagnosed?
As there is no way to see into the placenta to identify if there are any abnormal blood vessel connections, twin to twin transfusion syndrome is diagnosed based on clinical symptoms. Symptoms of TTTS include the following:
- Difference in fetal size – If there is a significant size discrepancy between the two babies, this can be indicative of TTTS
- Oligohydramnios/Polyhydramnios – If there is a difference in the amniotic fluid levels between the babies, this can be a sign of TTTS. As mentioned above, one baby will often have too much amniotic fluid (polyhydramnios) while the other baby does not have enough amniotic fluid (oligohydramnios)
- Size of the umbilical cord – It is often observed in cases of TTTS that there will be a noticeable size difference between each baby’s umbilical cord. The donor twin’s cord will appear smaller while the recipient twin’s umbilical cord will appear larger
Staging of Twin to Twin Transfusion Syndrome
Babies diagnosed with TTTS are staged based on presentation to predict severity of the condition. According to Cincinnati Children’s Hospital, staging includes the following:
- Stage I – There is only a difference in the amount of amniotic fluid in each baby’s sac
- Stage II – The smaller baby’s bladder is unable to be visualized by ultrasound
- Stage III – There is an abnormal blood flow through the umbilical cord, or the vessels around the heart
- Stage IV – There is an abnormal fluid collection in more than one body cavity (hydrops), which can be present in one or both twins
- Stage V – One of both of the twins has died
Treatment Options for Twin to Twin Transfusion Syndrome
While TTTS used to most often result in death for both, twin advances have been made, creating more opportunities for treatment of TTTS. Treatments for TTTS include the following:
- Fetoscopic laser surgery – this type of procedure involves insertion of a scope camera through the mother’s abdominal wall and into the womb, allowing the doctor to see the abnormal blood vessel connections inside the placenta. A laser can then be used to seal off and cut out any abnormal connections, leading only normal blood vessels
- Amniocentesis – An amniocentesis is typically used to draw out amniotic fluid for testing. In cases of TTTS, it can also be used to remove excess volumes of amniotic fluid. The removal of excess amniotic fluid allows for improved blood circulation in the placenta, lowering the risks of premature delivery and other complications
Twin to Twin Transfusion Syndrome Medical Malpractice
While this complication is completely unavoidable, it is essential for the healthcare provider to diagnose and treat TTTS in a timely manner. Failure to do so can result in death for one of more of the multiples. Examples of medical malpractice related to TTTS includes the following:
- Failure to diagnose TTTS
- Failure to treat TTTS
- Failure to refer to an appropriate specialist (i.e. high risk obstetrician)
- Failure to conduct appropriate monitoring for cases of TTTS
- Improper performance of an amniocentesis or fetoscopic laser surgery, leading to harm of one or more of the multiples
Medical Malpractice Can the Failure to Diagnose Twin Transfusion Syndrome
If you or a loved one have been seriously injured or killed as a result of medical malpractice contact the Oregon Medical Malpractice Lawyers at Kuhlman Law at our number below or fill out the intake form. We offer a free initial case evaluation and handle cases on a contingency fee which means that you pay no money unless we recover.
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