Which condition can lead to ischemic brain injury in a recipient twin during Quintero staging?

In the context of Quintero staging, which is used to assess and classify the severity of twin-to-twin transfusion syndrome (TTTS), it is crucial to understand the implications of various conditions associated with this syndrome. Blood pressure instability in the recipient twin can lead to significant hemodynamic changes.

In TTTS, one twin (the donor) may experience a decrease in blood volume and perfusion, leading to oligohydramnios, while the other twin (the recipient) may exhibit increased blood volume and hypervolemia, contributing to hydrops. This imbalance can cause fluctuations in blood pressure, which subsequently affects cerebral perfusion. The instability in blood pressure may result in periods of hypoperfusion or hyperperfusion in the brain of the recipient twin, leading to ischemic brain injury.

These ischemic events can stem from episodes of hypotension or other circulatory compromises that occur due to the dynamic nature of TTTS. Therefore, the presence of blood pressure instability is a critical factor that can directly lead to ischemic injury in the recipient twin, making it a significant concern during Quintero staging.

Other conditions like an absent bladder or hydrops can indicate the severity of the situation, but they do not directly