A Sonographer’s Perspective: Quintero Staging System for Twin-to-Twin Transfusion Syndrome in Monochorionic Twins

Sonography remains the cornerstone in the assessment of twin-to-twin transfusion syndrome in monochorionic twin pregnancies. Twin-to-twin transfusion is a common complication in monochorionic pregnancies, resulting in high perinatal morbidity and mortality rates. A disproportionate placental interconnection leads to hypovolemia and oligohydramnios in the donor twin and hypervolemia and polyhydramnios in the recipient twin. Ruben A. Quintero and his associates developed a staging system with definite sonographic criteria necessary for prognosis and management of these pregnancies. Quintero staging criteria consist of the following: stage 1, bladder of donor twin still visible; stage 2, bladder of donor twin no longer visible, no critical abnormal Doppler; stage 3, critical abnormal Doppler waveforms; stage 4, hydrops; and stage 5, demise of one or both twins.