An examination of the effects of current obstetrical opinions, diagnostic and practice trends in the management of twin to twin transfusion syndrome patients

Every year Twin to Twin Transfusion Syndrome (TTTS) claims the lives of thousands of unborn babies, and results in the premature births and life-limiting diagnoses of thousands more. TTTS is a well understood, yet under-recognized, placental disease affecting any given pregnancy at a rate of 1 in 1,000 (Centers for Disease Control). TTTS diagnoses do not disproportionately affect women based on age, race/ethnicity, socioeconomic status or geographic location. Unlike nearly all other diseases, there is no clustering of TTTS; instead the threat remains pathologically distinctive due to its pervasiveness. However, while incidence rates are random, survival rates are not.;Despite their compliant acceptance of "routine prenatal care," sadly, there are many women (from all ages, races and socioeconomic backgrounds) who for currently unknown reasons are not receiving the advanced prenatal care needed to appropriately screen for, diagnosis and treat TTTS. And these women are paying the ultimate price for such obstetrical oversight.;The central hypothesis of the study states that differential care being given by primary obstetricians of TTTS patients is resulting in experienced inequalities. Through both the ethnographic and quantitative analysis of primary data, this study seeks to divulge the complex social processes taking place (or failing to take place) within the world of American obstetrics and begin to understand how they are affecting TTTS mortality and morbidity rates.;Findings illuminate a profound imbalance of power and influence amongst the following entities: ACOG (The American Congress of Obstetricians and Gynecologists) and SMFM (Society of Maternal Fetal Medicine); obstetrical training and practice; and levels of patient awareness and advocacy. This study argues that the current social relations being reproduced by these entities are perpetuating a climate that allows for disregard of proper TTTS management. Specifically, this study theoretically explores what social relations and subsequent (in)actions are being reproduced prior to TTTS diagnoses and applies the effects of those observations.