How can we diagnose and manage twin–twin transfusion syndrome?

Huber, Agnes; Hecher, Kurt

doi:10.1016/j.bpobgyn.2004.04.006

Cited by 78 publications

(50 citation statements)

References 58 publications

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“…The diagnosis of TTTS was made by standard prenatal ultrasound criteria. 19 All MC twin gestations were monitored according to a standard protocol, which consisted of a first-trimester determination of chorionicity, a detailed anomaly scan at 20 weeks of gestational age, and regular ultrasound assessment of growth, amniotic fluid volume and Doppler of the umbilical artery at least at 20, 24 and 28 weeks and fortnightly thereafter. Women with either nonreassuring fetal findings or with maternal complications were submitted to frequent but at least twice weekly maternal and fetal evaluations (i.e.…”

Section: Methodsmentioning

confidence: 99%

Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: a multicentre retrospective cohort study

Hack

Derks

Elias

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objective To study perinatal mortality rates in a cohort of 465 monochorionic (MC) twins without twin-twin transfusion syndrome (TTS) born at 32 weeks of gestation or later since reported interauterine fetal death (IUFD) rates >32 weeks of gestations in the literature vary, leading to varying recommendations on the optimal timing of delivery, and to investigate the relation between perinatal mortality and mode of delivery.Design Multicentre retrospective cohort study.Setting Ten perinatal referral centres in the Netherlands.Population All MC twin pregnancies without TTTS delivered at ‡32 weeks of gestation between January 2000 and December 2005.Methods The medical records of all MC twin pregnancies without TTTS delivered at the ten perinatal referral centres in the Netherlands between January 2000 and December 2005 were reviewed.Main outcome measures Perinatal mortality in relation to gestational age and mode of delivery at ‡32 weeks of gestation.Results After 32 weeks of gestation, five out of 930 fetuses died in utero and there were six neonatal deaths (6 per 1000 infants).In women who delivered ‡37 weeks, perinatal mortality was 7 per 1000 infants. Trial of labour was attempted in 376 women and was successful in 77%. There were three deaths in deliveries with a trial of labour (8 per 1000 deliveries), of which two were related to mode of delivery. Infants born by caesarean section without labour had an increased risk of neonatal morbidity and respiratory distress syndrome.Conclusions In MC twin pregnancies the incidence of intrauterine fetal death is low ‡32 weeks of gestation. Therefore, planned preterm delivery before 36 weeks does not seem to be justified. The risk of intrapartum death is also low, at least in tertiary centres.

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Section: Methodsmentioning

confidence: 99%

Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: a multicentre retrospective cohort study

Hack

Derks

Elias

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic placentas in which unbalanced placental anastomoses lead to hypovolemia and oligohydramnios and intrauterine growth restriction of the donor twin, and hypervolemia, polyhydramnios and cardiac failure of the recipient twin 1 . Fetoscopic laser therapy of the communicating vessels has been shown to be safe, effective and superior to serial amniodrainage in twin pregnancies 2 .…”

Section: Introductionmentioning

confidence: 99%

Laser therapy of twin‐to‐twin transfusion syndrome in triplet pregnancies

Diemert

Diehl

Huber

et al. 2009

Ultrasound in Obstet & Gyne

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“…TTTS affects 10-15% of monochorionic twin pregnancies and results from unbalanced inter-twin blood transfusion through placental vascular anastomoses, that leads to hypovolaemia and oligohydramnios in the donor and hypervolaemia and polyhydramnios in the recipient [7,9]. Two small case series reported an incidence of severe PPHN of 26-30/1,000 TTTS newborns, most of which were recipients [10,11].…”

Section: Introductionmentioning

confidence: 99%

Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study

Gijtenbeek

Haak²,

Harkel³

et al. 2017

Neonatology

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Background: Persistent pulmonary hypertension of the newborn (PPHN) is associated with severe morbidity and mortality. Twin-twin transfusion syndrome (TTTS) is suggested to increase the risk of PPHN. Objectives: To describe the incidence of PPHN in TTTS twins and to identify risk factors in TTTS twins for the development of severe PPHN. Methods: Cases with severe PPHN were extracted from our monochorionic twin database (2002-2016). Severe PPHN was defined as severe hypoxaemia requiring mechanical ventilation and inhaled nitric oxide (iNO) treatment, confirmed by strict echocardiographic criteria. A case-control comparison within TTTS survivors was conducted to identify risk factors for PPHN. Results: The incidence of PPHN in TTTS twins was 4% (24/598, 95% confidence interval [CI] 2.7-5.9%) and 0.4% (2/493, 95% CI 0.1-1.5%) in uncomplicated monochorionic twins (odds ratio [OR] 10.3, 95% CI 2.4-43.9; p = 0.002). Two risk factors were independently associated with PPHN: severe prematurity (OR 3.3, 95% CI 1.0-11.4) and recipient status (OR 3.9, 95% CI 1.4-11.0). In TTTS recipients, another risk factor for PPHN is anaemia at birth (OR 7.2, 95% CI 1.8-29.6). Conclusion: Clinicians caring for neonates with TTTS should be aware of the 10-fold increased risk of PPHN compared to uncomplicated monochorionic twins. PPHN occurs more often in case of premature delivery and in recipient twins, particularly in the presence of anaemia at birth. As the development of severe PPHN is difficult to predict, we advise that all TTTS twins should be delivered in a tertiary care centre with iNO treatment options.

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How can we diagnose and manage twin–twin transfusion syndrome?

Cited by 78 publications

References 58 publications

Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: a multicentre retrospective cohort study

Perinatal mortality and mode of delivery in monochorionic diamniotic twin pregnancies ≥32 weeks of gestation: a multicentre retrospective cohort study

Laser therapy of twin‐to‐twin transfusion syndrome in triplet pregnancies

Persistent Pulmonary Hypertension of the Newborn in Twin-Twin Transfusion Syndrome: A Case-Control Study

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