الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The incidence of twin pregnancy is rising and monochorionic twin pregnancies are at increased risk for adverse outcome compared to dichorionic twin.
TTTS is one of the complications of monochorionc twin pregnancy and is thought to be secondary to a chronic imbalance of inter-twin blood flow and haemodynamic pressures within the donor and recipient twin fetal circulations.
The poor outcome of untreated TTTS led to the introduction of a number of interventions, including repeated serial amnioreduction, endoscopic laser photocoagulation of vascular anastomoses, amniotic septostomy and, in rare cases, in which the demise of the cotwin was certain, selective feticide.
Digoxin use was introduced for the treatment of cardiac failure in the recipient twin and proven successful.
The aim of this study was to evaluate the effectiveness of the use of oral digoxin in the treatment of early diagnosed cases of twin to twin transfusion syndrome.
Nine twin pregnant women where TTTS confirmed on ultrasound basis were included in the study.
All patients received 0.25 mg oral digoxin daily till delivery
Data collected prospectively on patient history included maternal age, last menstrual period, obstetric history and medical history.
Follow up ultrasound and Doppler were performed for all patients every two weeks till delivery to assess the donor and recipient fetal weight, weight discordance percentage, amount of liquor, the urinary bladder shadow and the umbilical artery resistance through assessing the S/D ratio.
Data collected on pregnancy outcome were based on gestational age at delivery, route of delivery and fetal condition, including neonatal birth weight, neonatal hemoglobin level, neonatal jaundice and the need for exchange blood transfusion.
Regarding the EFW of the donor and recipient, there was a significant increase in the fetal weight at follow up intervals till delivery with noted improvement in the weight discordance percentage with mean percentage of 25.5 ± 14.6% at birth.
Regarding the DVP, it remained within the normal range throughout the follow up periods with the lowest mean DVP for the donor twin 3.0 ± 0.63 and maximum mean for the recipient 7.67 ± 0.82.
Regarding the fetal doppler, umbilical artery S/D remained within the normal values for both the donor and the recipient twin throughout the follow up intervals.
Two cases developed preterm labour pains, the first was at the gestational age of 25 weeks+3days and spontaneous abortion occurred while the other case was at the age of 27 weeks and hysterotomy was done with the result of abortion of the donor twin and a still born recipient twin.