medigraphic.com
ISSN 1561-3062 (Electronic)

2016, Number 4

<< Back Next >>

Revista Cubana de Obstetricia y Ginecología 2016; 42 (4)

Management of twin-twin transfusion syndrome in monochorionic twin gestations

Pantoja GM, Frías SZ, Marchena RAM

Language: Spanish
References: 17
Page: 502-511
PDF size: 438.25 Kb.


ABSTRACT

Twin-twin transfusion syndrome is one of the most serious complications of monochorionic multiple gestations. Its etiology is due to a chronic blood transfusion from de donor twin to the recipient twin through the vascular anastomoses between the placental territories of both fetuses. The characteristic clinical presentation appears in both donor and recipient fetuses, as a direct consequence of altered volemia in each one. Polyhydramnios related to polyuria resulting from a state of constant hypervolemia is observed in the recipient twin, finally evolving into congestive heart failure. The clinical presentation in the donor twin is reversed and characterized by oligoamnios, oliguria, retarded intrauterine growth and hypovolemia, with untreated mortality rates ranging 80-100 % of all cases, which may vary depending on the severity of the transfusion. The diagnosis is based on exhaustive echographic examination of both fetuses to make an early diagnosis and correct staging, since the prognosis depends very much on early action. The treatment of choice is fetoscopic laser coagulation of vascular anastomoses between 18 and 26 weeks of gestation. The prognosis is variable, depending on the availability of fetal therapy and the gestational age at diagnosis, being prognosis generally very poor without an effective treatment.


REFERENCES

  1. Thia E, Thain S, Yeo GS. Fetoscopic laser photocoagulation in twin-to-twin transfusion syndrome: experience from a single institution. Singapore Med J. 2016;8:1-17.

  2. Gapp-Born E, Sananes N, Weingertner AS, Guerra F, Kohler M, Fritz G, et al. Predictive value of cardiovascular parameters in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014;44(4):427-33.

  3. Akkermans J, Peeters SH, Klumper FJ, Lopriore E, Middeldorp JM, Oepkes D. Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review. Fetal Diagn Ther. 2015;38:241-53.

  4. Yamamoto M, Ville Y. Laser treatment in twin-to-twin transfusion syndrome. Semin Fetal Neonatal Med. 2007;12(6):450-7.

  5. Papanna R, Mann LK, Johnson A, Sangi-Haghpeykar H, Moise KJ Jr. Chorioamnion separation as a risk for preterm premature rupture of membranes after laser therapy for twin-twin transfusion syndrome. Obstet Gynecol. 2010 Apr;115(4):771-6.

  6. Ahmed S, Luks F, O'Brien BM, Muratore CS, Carr SR. Influence of experience, case load, and stage distribution on outcome of endoscopic laser surgery for TTTS. Prenatal Diag. 2010;30:314-9.

  7. Akkermans J, Peeters SH, Middeldorp JM, Klumper FJ, Lopriore E, Ryan G, Oepkes D. A worldwide survey of laser surgery for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2015 Feb;45(2):168-74.

  8. Lopriore E, van den Wijngaard JPHM, Middeldorp JM, Oepkes D, Walther FJ, van Gemert MJ, Vandenbussche FPHA. Assessment of feto-fetal transfusion flow through placental arterio-venous anastomoses in a unique case of twin-to-twin transfusion syndrome. Placenta. 2007;28(2-3):209-11.

  9. Chang YL, Wang TH, Chang SD, Chao AS, Hsieh P. Fetoscopic laser coagulation of intertwin anastomoses reduces discordant placental autophagic activities in discordant twin growth. Taiwanese Journal of Obstetrics & Gynecology. 2015;54(5):580-2.

  10. Dias Gherpell JL. Twin-twin transfusion syndrome: what really matters concerning developmental outcome of survivals? Arq. Neuro-Psiquiatr. 2015;73(3).

  11. Baud D, Windrim R, Van Mieghem T, Keunen J, Seaward G, Ryan G. Twin-twin transfusion syndrome: a frequently missed diagnosis with important consequences. Ultrasound Obstet Gynecol. 2014 Aug;44(2):205-9.

  12. Van Mieghem T, Doné E, Gucciardo L, Klaritsch P, Allegaert K, Van Bree R, et al. Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2010 Jan;202(1):48.

  13. Valsky DV, Eixarch E, Martinez JM, Crispi F, Gratacós E. Selective intrauterine growth restriction in monochorionic twins: pathophysiology, diagnostic approach and management dilemmas. Semin Fetal Neonatal Med. 2010 Dec;15(6):342-8.

  14. Baschat AA, Gungor S, Glosemeyer P. Changes in umbilical venous volume flow after fetoscopic laser occlusion of placental vascular anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2010;203:479.e1-6.

  15. Quintero RA, Bornick PW, Allen MH, Johson PK. Selective laser photocoagulation of communicating vessels in severe twin-twin transfusion syndrome in women with an anterior placenta. Obstet Gynecol. 2001;97:477-81.

  16. Deprest JA, Devlieger R, Srisupundit K, Beck V, Sandaite I, Rusconi S, et al. Fetal surgery is a clinical reality. Semin Fetal Neonatal Med. 2010 Feb;15(1):58-67.

  17. Akkermans J, Peeters SH, Klumper FJ, Middeldorp JM, Lopriore E, Oepkes D. Is the Sequential Laser Technique for Twin-to-Twin Transfusion Syndrome Truly Superior to the Standard Selective Technique? A Meta-Analysis. Fetal Diagn Ther. 2015;37(4):251-8.




2020     |     www.medigraphic.com