Perinatal survival in cases of twin–twin transfusion syndrome complicated by selective intrauterine growth restriction

Winden, Kristi R. Van; Quintero, Rubén A.; Kontopoulos, Eftichia V.; Korst, Lisa M.; Llanes, Arlyn; Chmait, Ramen H.

doi:10.3109/14767058.2014.960834

Cited by 35 publications

(42 citation statements)

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“…There are numerous genetic abnormalities, structural anomalies, or perinatal insults that can affect brain development resulting in microcephaly . In our cohort, the fetal growth restriction and lagging preoperative HC measurements were due to the underlying pathophysiology of TTTS . This notion is further supported by the finding that the majority (83%) of fetuses with microcephaly also concurrently had overall symmetrical IUGR.…”

Section: Discussionsupporting

confidence: 66%

“…[20][21][22] In our cohort, the fetal growth restriction and lagging preoperative HC measurements were due to the underlying pathophysiology of TTTS. 23 This notion is further supported by the finding that the majority (83%) of fetuses with microcephaly also concurrently had overall symmetrical IUGR. After laser surgery, the donor twin is permitted catch-up growth due to cessation of shunting of blood volume and nutrients to the recipient twin through vascular communications.…”

Section: Discussionmentioning

confidence: 84%

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The relationship between preoperative fetal head circumference and 2‐year cognitive performance after laser surgery for twin‐twin transfusion syndrome

et al. 2018

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 84%

The relationship between preoperative fetal head circumference and 2‐year cognitive performance after laser surgery for twin‐twin transfusion syndrome

et al. 2018

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“…The remaining 35% (n = 128) were categorized within the TTTS-only group. Detailed analysis of this population has been previously described [1]. …”

Section: Resultsmentioning

confidence: 99%

“…In a recent analysis of 369 consecutive TTTS patients treated with laser surgery, 65% of the cases were complicated by SIUGR [1]. …”

Section: Introductionmentioning

confidence: 99%

Decreased Total Placental Mass Found in Twin-Twin Transfusion Syndrome Gestations with Selective Growth Restriction

Winden

Quintero²,

Kontopoulos³

et al. 2016

Fetal Diagn Ther

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Introduction: We examined placental weight characteristics associated with donor selective intrauterine growth restriction (SIUGR) among patients with twin-twin transfusion syndrome (TTTS) who underwent laser surgery. Materials and Methods: Fresh placental specimens were studied. Pregnancies with higher-order multiples, fetal demise, or disrupted or nonsubmitted placental specimens were excluded. Placental characteristics prospectively collected included total placental weight, individual placental weight, and placental share. Data were compared between pregnancies with SIUGR (TTTS + SIUGR group) and those without SIUGR (TTTS-only group). Results: Of 369 consecutive patients who underwent laser surgery for TTTS, 155 (42%) met inclusion criteria: 91 with TTTS + SIUGR and 64 with TTTS-only. Compared to the TTTS-only group, patients in the TTTS + SIUGR group had a lower total placental weight (608 ± 163 vs. 687 ± 224 g, p = 0.012), with a lower donor individual placental weight (237 ± 91 vs. 291 ± 124 g, p = 0.002), but no apparent difference in the individual placental weight of recipient twins (371 ± 109 vs. 396 ± 133 g, p = 0.211). Donor placental share was smaller in those pregnancies affected by SIUGR (38.7 ± 9.6 vs. 42.3 ± 9.8%, p = 0.029). Discussion: TTTS patients with SIUGR had a lower total placental weight and a lower donor individual placental weight compared to those without SIUGR. These findings suggest that differences in donor individual placental weights for SIUGR gestations may not solely be related to differences in placental share.

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“…Afortunadamente esta situación ha mejorado considerablemente en los estudios publicados en la última década. Sin embargo, algunas series de STFF manifiestan hasta un 50% de los casos la coexistencia de ambas entidades 63 . Las características más importantes para diferenciar entre un STFF o una RCIUs son el líquido amniótico y la disparidad de peso.…”

Section: Manejo Del Embarazo Y Seguimientounclassified

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Cosp

2016

Rev. Nac. (Itauguá)

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RESUMENLa Restricción Selectiva del Crecimiento Intrauterino se produce en 10 a 19% de los gemelos monocoriónicos y se asocia con un aumento importante de la mortalidad y la morbilidad perinatal. La evolución clínica está dada en gran parte por la presencia de anastomosis vaculares y la distribución placentaria asimétrica. Se propuso una clasificación en tres tipos según el Doppler de la arteria umbilical del gemelo más pequeño, la que sé que se correlaciona con distintos comportamientos clínicos y características de la placenta, lo que ayuda en el asesoramiento y conducta obstétrica. Los del tipo I tienen un pronóstico favorable por el resultado perinatal satisfactorio por lo que se recomienda un seguimiento cercano por ecografía y Doppler. Los de tipo II tienen un mal pronóstico y el tipo III un pronóstico intermedio e impredecible. En estos dos últimos se puede realizar un manejo expectante hasta que se observe deterioro del feto pequeño, considerando la posibilidad de la coagulación con láser o la oclusión del cordón (feticidio selectivo). Ambas conductas aparentemente aumentan las posibilidades de supervivencia del feto de peso normal.Palabras claves: restricción selectiva del crecimiento intrauterino, diagnóstico, manejo, gemelos monocoriales, doppler, terapia fetal ABSTRACT Selective intrauterine growth restriction occurs in 10-19% of monochorionic twins and is associated with increased mortality important and perinatal morbidity. The clinical course is given largely by the presence of placental vascular anastomosis and asymmetric distribution. It classified into three types according to the proposed Doppler umbilical artery smaller twin, the one that correlates with different clinical behaviors and characteristics of the placenta, which helps in counseling and obstetric conduct. The type I have a favorable prognosis for satisfactory perinatal outcome so closely monitored by ultrasound and Doppler is recommended. The type II has a poor prognosis and type III intermediate and unpredictable prognosis. In these last two you can make an expectant management until deterioration of the small fetus is observed, considering laser coagulation or cord occlusion(selective feticide). Both behaviors appear to increase the chances of survival of the fetus of normal weight.

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Perinatal survival in cases of twin–twin transfusion syndrome complicated by selective intrauterine growth restriction

Abstract: SIUGR, present in two-thirds of TTTS patients, was a risk factor for decreased donor survival. Patients with donor SIUGR and umbilical artery persistent or reversed end-diastolic flow (Quintero Stage III Donor-involved) were especially at risk.

Cited by 35 publications

References 13 publications

The relationship between preoperative fetal head circumference and 2‐year cognitive performance after laser surgery for twin‐twin transfusion syndrome

The relationship between preoperative fetal head circumference and 2‐year cognitive performance after laser surgery for twin‐twin transfusion syndrome

Decreased Total Placental Mass Found in Twin-Twin Transfusion Syndrome Gestations with Selective Growth Restriction

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

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