A 35 yo g2p1001 at 19w4d with mo-di twins complicated by twin-to-twin transfusion syndrome, ttts stage iii and first trimester bleeding which led to a large subchorionic hematoma.Us findings for twin a , the recipient had reversed awave of the dvand the twin b , the donor had intermittent absent edf of the ua.The growth discordance was 18%.She underwent fetoscopic laser photocoagulation of placental anastomosis for ttts on (b)(6) 2023.The risk of her surgery was discussed in detail but that included further membrane separation that could lead to premature preterm rupture of membranes after the surgery.She was also at risk for placental abruption.At the same time if she did not perform surgery, she was at risk losing one or both twins.The surgery itself was uneventful.One pod#1 she was found to have significant amount of chorioamniotic separation.She was not leaking but later that afternoon she ruptured her membranes.She remained stable and the twins recovered from surgery with concordant fluid, bladder seen and normal dopplers.She resealed and reaccumulated fluid in both twins.She had latency antibiotics.However, at 22w1d, the days prior she had severe preeclampsia and underwent c-section for delivery of her twins.Twin b -former donor on day of life 10 became hemodynamically unstable with low pressure, abdominal distension with increased loops of bowel.X-ray noted to have pneumatosis.Abx was given.Received multiple transfusions of prbc, platelets, and ffp.Massive transfusion protocol initiated during pulmonary hemorrhage event and passed on dol 11.Ref report: mw5150228.
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