Stage III: In addition to the characteristics of Stages I and II, there is abnormal blood flow in the umbilical cords of the twins. Stage IV: In addition to all of the above findings, the recipient twin has swelling under the skin and appears to be experiencing heart failure (fetal hydrops). Stage V: In addition to all of the above findings, one of the twins has died. This can happen to either twin. The risk to either the donor or the recipient is roughly equal & is quite high in Stage II or higher TTTS. The Quintero staging does not provide information about prognosis, and other staging systems have been proposed. Treatment
Various treatments exist for TTTS. Non treatment
This is equivalent of zero intervention. It has been associated with almost 100% mortality rate of one or all fetuses. Exceptions to this include patients that are still in Stage 1 TTTS and are past 22 weeks gestation. Adjustment of amniotic fluid
Serial amniocentesis
This procedure involves removal of amniotic fluid periodically throughout the pregnancy under the assumption that the extra fluid in the recipient twin can cause preterm labor, perinatal mortality, or tissue damage. In the case that the fluid does not reaccumulate, the reduction of amniotic fluid stabilizes the pregnancy. Otherwise, the treatment is repeated as necessary. There is no standard procedure for how much fluid is removed each time. There is a danger that if too much fluid is removed, the recipient twin could die.
That is, when the phoneme /h/ precedes a vowel, /h/ may be realized as a voiceless version of the subsequent vowel. For example the word ⟨hit⟩, /hɪt/ is realized as [ɪ̥ɪt]. H is the eighth most frequently used letter in the English language (after S, N, I, O, A, T, and E), with a frequency of about 4.2% in words. When h is placed after certain other consonants, it modifies their pronunciation in various ways, e.g. for ch, gh, ph, sh, and th. Other languages
In the German language, the name of the letter is pronounced /haː/. Following a vowel, it often silently indicates that the vowel is long: In the word erhöhen (heighten), the second ⟨h⟩ is mute for most speakers outside of Switzerland. In 1901, a spelling reform eliminated the silent ⟨h⟩ in nearly all instances of ⟨th⟩ in native German words such as thun (to do) or Thür (door). It has been left unchanged in words derived from Greek, such as Theater (theater) and Thron (throne), which continue to be spelled with ⟨th⟩ even after the last German spelling reform. In Spanish and Portuguese, ⟨h⟩ ("hache" in Spanish, pronounced [atʃe], or agá in Portuguese, pronounced [aˈɣa] or [ɐˈɡa]) is a silent letter with no pronunciation, as in hijo [ˈixo] (son) and húngaro [ˈũɡaɾu] (Hungarian). The spelling reflects an earlier pronunciation of the sound /h/.