Suspected twin-twin transfusion syndrome in a regional centre — referral and communication station

You are the obstetric registrar in a regional centre. A 26-year-old G1P0 at 19+4 weeks with a known monochorionic diamniotic twin pregnancy presents with one week of increasing abdominal distension and breathlessness. The surveillance scan shows a recipient twin with deepest vertical pool of 9.5 cm, a donor twin stuck against the uterine wall with deepest vertical pool of 1.5 cm and no visible bladder over the observation period, both twins with positive end-diastolic flow in the umbilical artery and no ascites. The fetal therapy centre is a 90-minute flight away. The woman has a partner at home and no other children. The assessor runs the clock and feeds you the woman's questions and her emotional responses.