Twin-to-twin transfusion syndrome (TTTS)*

Abstract Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic (MC) twin pregnancies, characterized by the development of unbalanced chronic blood transfer from one twin, defined as donor twin, to the other, defined as recipient, through placental anastomoses. If left untreated, TTTS is associated with very high perinatal mortality and morbidity rates, due to a combination of fetal and/or obstetric complications. The reported prevalence is 10–15% of all MC twins, or about 1 in 2000 pregnancies. This consensus document reviews available evidence and offers practical guidance to clinicians by providing recommendations on various aspects concerning diagnosis and management of TTTS.

[1]  Machin Ga.  Velamentous cord insertion in monochorionic twin gestation. An added risk factor. , 1997, The Journal of reproductive medicine.

[2]  R. Quintero,et al.  Staging of Twin-Twin Transfusion Syndrome , 1999, Journal of Perinatology.

[3]  M. Hansmann,et al.  Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome. , 1999, American journal of obstetrics and gynecology.

[4]  R. Quintero,et al.  Selective versus non‐selective laser photocoagulation of placental vessels in twin‐to‐twin transfusion syndrome , 2000, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[5]  N M Fisk,et al.  Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome. , 2000, American journal of obstetrics and gynecology.

[6]  K. Hecher,et al.  Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. , 2000, European journal of obstetrics, gynecology, and reproductive biology.

[7]  N. Fisk,et al.  Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry. , 2001, American journal of obstetrics and gynecology.

[8]  M. Gubler,et al.  Pathogenesis of Twin-Twin Transfusion Syndrome: The Renin-Angiotensin System Hypothesis , 2001, Fetal Diagnosis and Therapy.

[9]  K. Zerres,et al.  Neurodevelopmental risks in twin-to-twin transfusion syndrome: preliminary findings. , 2001, European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society.

[10]  M. V. van Gemert,et al.  Monochorionic twins and twin-twin transfusion syndrome: the protective role of arterio-arterial anastomoses. , 2002, Placenta.

[11]  N. Fisk,et al.  Validation of the Quintero Staging System for Twin‐Twin Transfusion Syndrome , 2002, Obstetrics and gynecology.

[12]  R. Quintero,et al.  Twin-twin transfusion syndrome. , 2003, Clinics in perinatology.

[13]  S. Evans,et al.  The progression of disease stage in twin-twin transfusion syndrome. , 2004, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[14]  N. Fisk,et al.  Doppler for Artery–Artery Anastomosis and Stage-Independent Survival in Twin–Twin Transfusion , 2004, Obstetrics and gynecology.

[15]  G. Bevilacqua,et al.  The policy of antenatal corticosteroid administration in Italy vs. other European countries. , 2004, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[16]  Radiofrequency ablation for TRAP sequence , 2004 .

[17]  Chi Poissy,et al.  Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome* , 2004 .

[18]  N. Fisk,et al.  Stage-based treatment of twin-twin transfusion syndrome. , 2004, American journal of obstetrics and gynecology.

[19]  R. Friedman,et al.  Vascular distribution patterns in monochorionic twin placentas. , 2005, Placenta.

[20]  T. Crombleholme,et al.  Twin-twin transfusion syndrome: where do we go from here? , 2005, Seminars in perinatology.

[21]  R. Quintero,et al.  Management of twin–twin transfusion syndrome in pregnancies with iatrogenic detachment of membranes following therapeutic amniocentesis and the role of interim amniopatch , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[22]  G. Saade,et al.  A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome. , 2005, American journal of obstetrics and gynecology.

[23]  Jan Deprest,et al.  Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. , 2006, American journal of obstetrics and gynecology.

[24]  Long-term neurodevelopmental outcome of 167 children after intrauterine laser treatment for severe twin-twin transfusion syndrome , 2006 .

[25]  K. Hecher,et al.  Stage-Related Outcome in Twin–Twin Transfusion Syndrome Treated by Fetoscopic Laser Coagulation , 2006, Obstetrics and gynecology.

[26]  R. Chmait,et al.  Sequential selective laser photocoagulation of communicating vessels in twin–twin transfusion syndrome , 2007, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[27]  N. Fisk,et al.  Stage I twin–twin transfusion syndrome: rates of progression and regression in relation to outcome , 2007, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[28]  S. Dymarkowski,et al.  Placental sharing, birthweight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas. , 2006, American journal of obstetrics and gynecology.

[29]  J. Rychik,et al.  The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. , 2007, American journal of obstetrics and gynecology.

[30]  R. Romero,et al.  Taking the American Journal of Obstetrics & Gynecology into the 21st century. , 2007, American journal of obstetrics and gynecology.

[31]  E. Lopriore,et al.  Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery? , 2007, BJOG : an international journal of obstetrics and gynaecology.

[32]  Y. Ville,et al.  Emergency cerclage in cases of twin‐to‐twin transfusion syndrome with a short cervix at the time of surgery and relationship to perinatal outcome , 2008, Prenatal diagnosis.

[33]  Jan Deprest,et al.  The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. , 2008, American journal of obstetrics and gynecology.

[34]  T. Crombleholme,et al.  Initial fetal cardiovascular profile score predicts recipient twin outcome in twin-twin transfusion syndrome. , 2008, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[35]  M. V. van Gemert,et al.  Twin–twin transfusion syndrome: mathematical modelling , 2008, Prenatal diagnosis.

[36]  M. V. van Gemert,et al.  Placental characteristics of monochorionic diamniotic twin pregnancies in relation to perinatal outcome. , 2008, Placenta.

[37]  Clinical outcomes in VBAC attempts: what to say to patients? , 2008, American journal of obstetrics and gynecology.

[38]  Vincenzo D'Addario,et al.  Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. , 2008, American journal of obstetrics and gynecology.

[39]  N. Fisk,et al.  The placenta contributes to activation of the renin angiotensin system in twin-twin transfusion syndrome. , 2008, Placenta.

[40]  V. D’addario,et al.  The Efficacy of Quintero Staging System to Assess Severity of Twin–Twin Transfusion Syndrome Treated with Laser Therapy: A Systematic Review with Meta-Analysis , 2009, American journal of perinatology.

[41]  E. Lopriore,et al.  Short- and long-term outcome in stage 1 twin-to-twin transfusion syndrome treated with laser surgery compared with conservative management. , 2008, American journal of obstetrics and gynecology.

[42]  T. Crombleholme,et al.  Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience. , 2009, American journal of obstetrics and gynecology.