skip to main content

HELLP syndrome — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePregnancy ComplicationsHELLP syndromeMCCQE Part 1

At 21 weeks, a monochorionic diamniotic twin pregnancy has a deepest fluid pocket of 1.2 cm and no visible bladder in the smaller donor twin, while the recipient has a 10.5-cm pocket and a distended bladder. Both fetuses remain alive. What is the most appropriate next management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Urgent referral for fetoscopic laser ablation at a fetal-therapy centre

The polyhydramnios-oligohydramnios sequence in monochorionic diamniotic twins, together with an absent donor bladder, is established twin-to-twin transfusion syndrome of at least Quintero stage II. This requires urgent assessment at a tertiary fetal-therapy centre. Fetoscopic laser coagulation of the placental vascular anastomoses treats the underlying intertwin shunt and is the disease-modifying intervention for significant mid-gestation TTTS. Serial routine surveillance alone is unsafe at this stage. Delivery at 21 weeks has extremely poor neonatal prospects, while indomethacin changes fluid dynamics without correcting the vascular cause and cerclage does not treat placental anastomoses. Counselling must address procedure-related loss, membrane rupture and neurologic risk.

Reference: NICE TTTS Laser Guidance: https://www.nice.org.uk/guidance/htg126 ; NICE Twin Pregnancy Guideline: https://www.nice.org.uk/guidance/ng137/chapter/Recommendations