The Basic and Clinical Science of Twin–Twin Transfusion Syndrome

Fisk, Nicholas M.; Duncombe, Gregory; Sullivan, Mark

doi:10.1016/j.placenta.2009.02.005

Cited by 102 publications

(87 citation statements)

References 170 publications

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“…Another cardiovascular disorder that is suggested to increase the risk of PPHN is twin-twin transfusion syndrome (TTTS) [7,8]. 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].…”

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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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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“…It is readily diagnosed by ultrasound using internationally accepted criteria for discordant amniotic fluid volume [2,3,4]. Although the pathophysiology is not completely understood [2], fetoscopic laser ablation of placental vascular anastomoses combined with amniodrainage effectively separates the 2 fetal circulations and corrects the polyhydramnios, the factors linked inextricably to poor pregnancy outcome. Compared with no treatment or amniodrainage, fetoscopic laser surgery reduces the rate of preterm birth (PTB) and increases the likelihood of survival without neurologic morbidity [3,4,5].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

et al. 2016

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Objective: To evaluate the impact of entry method and access diameter at fetoscopic surgery for twin-twin transfusion syndrome in twin pregnancies with at least one survivor. The outcomes evaluated were prelabour rupture of membranes (PROM) and birth <4 weeks, preterm birth (PTB) <28 weeks, and latency to birth. Methods: A retrospective analysis of prospectively collected data of consecutive laser procedures from 6 centers was performed. Three entry methods (sheath + trocar; cannula + trocar; cannula + Seldinger) and 6 access diameters (2.3, 3.0, 3.3, 3.5, 3.8, 4.0 mm) were used. Exclusion criteria were subsequent invasive interventions, termination of pregnancy or double fetal death after laser. Multivariate analysis was performed to determine risk factors for the study outcomes. Results: Six hundred seventy three fetoscopic laser cases were analyzed. The use of different entry methods and access diameters did not affect PROM or birth <4 weeks, or latency from laser to birth. Access diameter was associated with PTB <28 weeks. Cervical length was associated with PROM and birth <4 weeks, and latency from laser to birth. Conclusion: Instrument choice at fetoscopic laser procedures did not affect outcomes <4 weeks. Access diameter may affect the likelihood for PTB <28 weeks. Cervical length is critically associated with obstetrical outcomes following laser surgery.

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“…The twin-to-twin transfusion syndrome (TTTS) complicates 10-20% of monochorionic twin gestations [1]. It is caused by unbalanced blood flow from one twin to another through placental anastomoses, resulting in hypervolemia, polyuria, and polyhydramnios in the recipient twin, and hypovolemia, anuria, and oligohydramnios in the donor twin [2].…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery

et al. 2014

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Introduction: To describe the incidence and risk factors for iatrogenic premature preterm rupture of membranes (iPPROM) after fetoscopic laser surgery for the twin-to-twin-transfusion syndrome. Materials and Methods: This is a retrospective review of all patients who have undergone fetoscopic laser surgery at a single fetal treatment center since 2000. We defined iPPROM as spontaneous rupture of membranes before the onset of labor prior to 34 weeks of gestation. The iPPROM cohort was compared to the cohort without iPPROM for several preoperative, operative, and delivery characteristics. Results: Ninety-two consecutive patients were reviewed. The overall rate of iPPROM was 18.5% (n = 17). The rates of iPPROM within 1 and 4 weeks were 5.4 and 10.9%, respectively. The median interval from surgery to delivery was significantly shorter in the iPPROM group (21 vs. 62 days, p = 0.01). The mean gestational age at delivery (27.0 vs. 31.1 weeks, p = 0.02) was lower in the iPPROM group. No other characteristics studied differed significantly between the groups. Discussion: The incidence of iPPROM was substantially lower than in recent multicenter reports; however, no risk factors of iPPROM could be identified. Whether this is related to variations in surgical or anesthetic management will require further investigation.

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The Basic and Clinical Science of Twin–Twin Transfusion Syndrome

Cited by 102 publications

References 170 publications

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

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

The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery

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