Management of atypical cases of twin-to-twin transfusion syndrome

Cruz‐Martínez, R.; Villalobos‐Gómez, R.; Gil-Pugliese, Savino; Gámez-Varela, Alma; López‐Briones, Hugo; Martínez‐Rodríguez, Miguel; Barrios-Prieto, Ernesto

doi:10.1016/j.bpobgyn.2022.03.011

Cited by 3 publications

(3 citation statements)

References 55 publications

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“…Doppler sonography in the new donor deteriorated to a highly pathologic flow in the venous system, leading to a caesarean section. These cases show that rigid diagnostic amniotic fluid criteria may underestimate the severity and incidence of TTTS, underscoring the importance of careful surveillance, including arterial and venous Doppler velocimetry, in all monochorionic pregnancies 3 , 13 , 14 .…”

Section: Discussionmentioning

confidence: 84%

“…A different clinical scenario involves TTTS overlapping with other monochorionic twin complications, such as selective intrauterine growth restriction (sIUGR). Any TTTS case that fails to meet the established diagnostic criteria is classified as atypical TTTS 3 , 4 . The aim of this case report to present a TTTS case does not meet the standard TTTS criteria, which is usually and the work has been reported in line with the Surgical CAse REport (SCARE) 2023 criteria 5 .…”

Section: Introductionmentioning

confidence: 99%

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Atypical Twin-to-Twin transfusion syndrome case managed in a single centre in indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Aldiansyah,

Halim,

Lumbanraja

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction and importance: The diagnostic criteria for Quintero staging in twin-to-twin transfusion syndrome (TTTS) are not applicable in all cases of TTTS, such as those in which the symptoms overlap with other monochorionic twin complications such as selective intrauterine growth restriction (sIUGR). Case Presentation: A 25-year-old woman, G1P0A0, At 22-24 weeks’ gestational age was diagnosed with TTTS, with no outstanding history of medication use during pregnancy, and no family history of genetic disorder or twin pregnancy. In the donor twin, persistently absent end-diastolic flow in the umbilical artery was observed using Doppler velocimetry. Polyhydramnios was observed in the recipient twins. The fetal weight discordance between the twins was 39%. After two weeks of follow-up, we performed fetoscopic laser photocoagulation and successfully ablated five vascular anastomoses and amnioreduction by 2.5 liters. Five days after the laser surgery, the patient developed amniotic fluid leakage, and an amniopatch was performed. We did the caesarean section at 34 weeks because of severe preeclampsia, the donor and recipient birth weights were 1,120 g and 1,837 g, respectively (weight discordance 39%). The APGAR scores were 3/4 and 6/8, respectively. The donor twin died six days after delivery due to respiratory failure, and the recipient twin survived. Neonatal echocardiography of the surviving twin showed no tricuspid regurgitation. No long-term follow-up was performed. Clinical discussion: The traditional diagnostic criteria for TTTS stage 3 were not met and overlapped with the diagnostic criteria for sIUGR type 2. This is the first procedure reported in Indonesia for Atypical TTTS with the outcome, one twin survived. Conclusion: Some TTTS cases do not meet traditional diagnostic criteria and overlap with other monochorionic twin complications.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Atypical Twin-to-Twin transfusion syndrome case managed in a single centre in indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Aldiansyah,

Halim,

Lumbanraja

et al. 2024

Annals of Medicine &Amp; Surgery

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“…It has been demonstrated that increasing umbilical venous flow can lead to elevating preload followed by an increasing stretch of the cardiac chamber, releasing natriuretic peptides and thus triggering dieresis and polyhydramnios. 13 Moreover, the secretion of endothelin as a vasoconstrictor can lead to hypertension which may result in cardiac hypertrophy and valvular defects. 14 Besides, in donor twins suffering from TTTS, hypovolemia can lead to oligohydramnios followed by the activation of the renin-angiotensin pathway leading to hypertension and thus cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

Doppler Finding, Cardiovascular Function Assessment, and Fetuses’ Survival Following the Fetoscopic Laser in Twin-to-Twin Transfusion Syndrome

Ezazi Bojnordi,

Eslamian,

Marsoosi

et al. 2023

J Lasers Med Sci

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Introduction: This study aimed to evaluate the effectiveness of selective laser photocoagulation of communicating vessels (SLPCV) on cardiac function in twins with twin-to-twin transfusion syndrome (TTTS). Methods: This retrospective cohort study evaluated 178 women with twin pregnancies complicated with TTTS and scheduled for SLPCV between 16 and 26 weeks of gestation. The severity of TTTS was determined by Quintero staging and the severity of cardiovascular disorders by the CHOP (Children’s Hospital of Philadelphia) score. Patient survival was evaluated through a one-month-after-birth follow-up of fetuses. Results: The study revealed significant improvements in Doppler indices in both donors and recipients after SLPCV. The CHOP score also significantly decreased after the intervention. One-month-after-birth survival rates were 55.1% in donors and 56.7% in recipients. Some Doppler indexes of fetuses before SLPCV could predict survival until one month after birth. Conclusion: The study suggests that SLPCV can improve cardiac function in fetuses with TTTS and that some Doppler indexes can predict survival outcomes. Additionally, the severity of TTTS can be a powerful indicator of the severity of cardiovascular complications.

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Too Much of a Good Thing: Updated Current Management and Perinatal Outcomes of Polyhydramnios

Wu,

Chen

2024

Journal of Medical Ultrasound

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Amniotic fluid assessment is crucial in prenatal ultrasound to monitor fetal conditions, with polyhydramnios, characterized by excessive amniotic fluid, affecting 1%–2% of pregnancies. Polyhydramnios is linked to complications such as placental abruption, preterm labor, congenital anomalies, and postpartum hemorrhage, emphasizing the need for early detection and management. While idiopathic causes account for 60%–70% of cases, other causes include impaired fetal swallowing and increased urine production due to maternal, fetal, and placental conditions. Accurate amniotic fluid volume (AFV) assessment and surveying the underlying cause are important, with ultrasound methods such as deep vertical pocket (DVP) and amniotic fluid index (AFI) preferred. Polyhydramnios is defined by an AFV exceeding 2000 ml, an AFI over 24 cm, or DVP more than 8 cm. Management typically targets underlying causes, with treatments such as amnioreduction and indomethacin for severe cases. Antepartum monitoring includes detailed fetal ultrasound, genomic and genetic examinations, and tests for maternal diabetes and infections. Intrapartum management addresses complications such as malpresentation and shoulder dystocia, whereas postpartum care involves monitoring for uterine atony and hemorrhage. Perinatal outcomes in idiopathic polyhydramnios are generally poorer, with increased risks of fetal demise, preterm delivery, and neonatal complications, but these results may need further stratification and verification.

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Management of atypical cases of twin-to-twin transfusion syndrome

Cited by 3 publications

References 55 publications

Atypical Twin-to-Twin transfusion syndrome case managed in a single centre in indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Atypical Twin-to-Twin transfusion syndrome case managed in a single centre in indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Doppler Finding, Cardiovascular Function Assessment, and Fetuses’ Survival Following the Fetoscopic Laser in Twin-to-Twin Transfusion Syndrome

Too Much of a Good Thing: Updated Current Management and Perinatal Outcomes of Polyhydramnios

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