Fetofetal transfusion syndrome: prenatal ultrasonographic diagnosis.

Brennan, James N.; Diwan, R V; Rosen, Mortimer G.; Bellon, Errol M.

doi:10.1148/radiology.143.2.7071360

Cited by 75 publications

(25 citation statements)

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“…2 Polyhydramnios and oligohydramnios were defined as deepest sonographic vertical pools of amniotic fluid of Ͼ8 cm and Ͻ1 cm, respectively. 11 Each case was staged at diagnosis: stage I, oligopolyhydramnios sequence only; stage II, "stuck" twin with absent visible bladder on ultrasound of the donor; stage III, AREDF of the umbilical artery or absence/reversal of flow during atrial contraction in DV; and stage IV, hydrops in either fetus. 12 After delivery, PWV was measured with the use of a noninvasive photoplethysmographic technique in the brachioradial artery.…”

Section: Methodsmentioning

confidence: 99%

Twin-Twin Transfusion Syndrome

et al. 2003

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Background-In twin-twin transfusion syndrome (TTTS), the donor and recipient fetus are exposed to differing volume loads and show discordant intertwin vascular compliance in childhood despite identical genotype. We hypothesized that discordance is prevented by intrauterine endoscopic laser ablation of placental anastomoses, which abolishes intertwin transfusion. We tested this by examining pulse wave velocity (PWV) in brachial arteries of twin survivors of TTTS treated with and without laser therapy. Methods and Results-One hundred children (50 twin pairs, 27 with TTTS) were studied. Group 1 comprised 14 monochorionic (MC) twin pairs with TTTS treated symptomatically; group 2 comprised 13 MC twin pairs with TTTS treated by laser. The control groups comprised 12 MC twin pairs without TTTS (group 3) and 11 dichorionic twin pairs (group 4). Fetal cardiovascular data, predictive factors for, and duration of TTTS and cord blood were collected prospectively. We measured blood pressure and PWV photoplethysmographically at a median corrected postnatal age of 11 months (range, 1 week to 66 months). Both TTTS groups showed marked intertwin PWV discordance, unlike MCDA control subjects. The PWV discordance seen in laser treated twin pairs resembled that of dichorionic control subjects (heavier individual with higher PWV), whereas group 1 showed the opposite (negative) intertwin discordance (ANOVA F (1,45)ϭ4.5, Pϭ0.04). No significant differences in blood pressure or intrauterine growth were observed between TTTS groups. Conclusions-Vascular programming is evident in monozygotic twins with intertwin transfusion and is altered but not abolished by intrauterine therapy to resemble that seen in dichorionic twins.

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Section: Methodsmentioning

confidence: 99%

Twin-Twin Transfusion Syndrome

et al. 2003

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“…At the time of delivery, the diagnosis was confirmed by clinical presentation such as cardiomegaly, cardiac dysfunction, or anemia-polycythemia [9], histologic examination of the placenta and dividing membrane. Velamentous cord insertions were also assessed following delivery.…”

Section: Methodsmentioning

confidence: 99%

Fetal Middle Cerebral Artery Doppler Waveforms in Twin–Twin Transfusion Syndrome

Suzuki

Sawa²,

Yoneyama³

et al. 1999

Gynecol Obstet Invest

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The aim of this study was to compare the fetal middle cerebral artery (MCA) Doppler waveforms in growth-retarded twin fetuses with (n = 11) and without (n = 24) twin–twin transfusion syndrome (TTTS). Umbilical artery (UA) and fetal MCA Doppler velocity waveforms were recorded on admission. The mean values of the UA pulsatility index (PI) of smaller twin fetuses with and without TTTS were significantly higher than those of normal singleton pregnancies. The mean values of the MCA PI of smaller twin fetuses in the TTTS group (+0.7 ± 1 SD) were significantly higher than those of normal singleton pregnancies on admission, and these levels did not markedly change following amniocentesis. On the other hand, the values of the MCA of the growth-retarded fetuses without TTTS (–0.9 ± 1 SD) were significantly lower than those of normal singleton pregnancies. Our findings suggest that measurement of fetal MCA PI is a useful method to assess growth-retarded fetuses in monochorionic twin pregnancies.

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“…Quintero et al 5 classified the disease according to its gravity in five stages. When TTTS occurs below 26 weeks fetal mortality can reach 90% 6,7 . Until early 90th's, many approaches where used in the management of TTTS: selective sacrifice of one twin (feticide), perforation of the inter twin membrane (septostomy) and serial amniodrenage 8 .…”

Section: Introductionmentioning

confidence: 99%

Laser for the treatment of twin to twin transfusion syndrome

et al. 2005

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Purpose:To report the initial experience in our country with a new technique for twin to twin transfusion syndrome (TTTS) treatment, using laser to coagulate the placental vessels responsible for the twin transfusion during gestation. Methods: Prospective study of eight cases diagnosed with TTTS evaluated in our service from january 2001 to june 2005. Through percutaneous introduction of a 2,0mm diameter fetoscope in the uterine cavity, placental surface vessels where directly visualized. Those identified as responsible for the transfusion were laser coagulated. The procedure combines ultrasonography and fetoscopy, in a so-called sonoendoscopic technique (FETENDO). Results: Among the eight pregnancies evaluated, five cases were submitted to the procedure (10 fetuses). All fetuses survived for at least five weeks after surgery. A total of eight fetuses were born alive and five survived the neonatal period. In a 18 months follow-up after birth, all five are still alive and well and their mean age is now 10,6 months. The total survival rate was 50% and in three pregnancies, at least one fetus survived. Conclusions: Laser fetoscopy is actually the "gold-standard" treatment of TTTS. Nevertheless is a sophisticated technique that depends of proper training. Our service is the first in our country to offer this therapeutic technique. Our success rate is comparable with the international literature.

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Fetofetal transfusion syndrome: prenatal ultrasonographic diagnosis.

Cited by 75 publications

References 0 publications

Twin-Twin Transfusion Syndrome

Twin-Twin Transfusion Syndrome

Fetal Middle Cerebral Artery Doppler Waveforms in Twin–Twin Transfusion Syndrome

Laser for the treatment of twin to twin transfusion syndrome

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