Twin-to-twin transfusion syndrome: A subset of the twin oligohydramnios-polyhydramnios sequence

Bruner, Joseph P.; Rosemond, Richard L.

doi:10.1016/0002-9378(93)90028-h

Cited by 72 publications

(33 citation statements)

References 21 publications

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“…1 The pathophysi ol ogy i s l i nked to pl acental vascul ar anastomoses betw een monochori oni c (M C) monozygous tw i ns. 2 How ever, TTTS i s consi dered by some to be poorl y understood 3 or eni gmati c 4 due to the l ack of cl assi c fi ndi ngs (hematocri t and w ei ght di fferences) i n the twins, 5 the inability to document transfusion of bl ood in vivo betw een the tw i ns i n each case, 3,6,7 the w i de and unpredi ctabl e cl i ni cal fl uctuati ons, 8 and the di ffi cul ty rel ati ng cl i ni cal outcome di rectl y to pl acental fi ndi ngs. 9 Despi te these concerns, the syndrome conti nues to affect approxi matel y 15% of previ abl e M C tw i ns w here hi gh morbi di ty and mortal i ty rates are seen both w i th and w i thout therapeuti c i nterventi ons.…”

Section: Introductionmentioning

confidence: 99%

Maternal metabolic abnormalities in twin–to–twin transfusion syndrome at mid–pregnancy

Lia

Kuhlmann²,

Emery³

2000

twin res

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We r epor t abnor mal mater nal l abor ator y par ameter s i n tw i n-to-tw i n tr ansfusi on syndr ome (TTTS) at mi d-pr egnancy. A r etr ospecti ve char t r evi ew w as under tak en of 109 pati ents w i th TTTS eval uated for pl acental l aser sur ger y. Compl ete bl ood count (CBC), bl ood type and Rh factor, ur i ne anal ysi s and ser um chemi str y panel w er e obtai ned pr eoper ati vel y, w i th the CBC and ser um al bumi n r epeated on the fi r st postoper ati ve day. The mean gestati onal age w as 21.2 ± 1.7 w eek s. I ni ti al abnor mal val ues i ncl uded hematocr i t (32.1 ± 3.0%), hemogl obi n (11.0 ± 1.03 g/dl ), ser um magnesi um (1.71 ± 0.17 mg/dl ), total pr otei n (6.08 ± 0.55 g/dl ) and al bumi n (3.06 ± 0.34 g/dl ). Despi te mi ni mal bl ood l oss and conser vati ve fl ui d r epl acement mean hematocr i t, hemogl obi n, and al bumi n w er e 27.3 ± 2.74%, 9.3 ± 0.94 g/dl and 2.56 ± 0.23 g/dl , r especti vel y on postoper ati ve day one. Wei ght gai n (8.0 ± 5.5 l b.) and l ow ur i nar y output w er e char acter i sti c per i -oper ati ve events. M ater nal hypopr otei nemi a and anemi a occur i n TTTS at mi d-pr egnancy. Thi s may contr i bute i ndependentl y to amni oti c fl ui d pr oducti on r ates i n the fetuses, and expl ai n i n par t the mater nal sensi ti vi ty to i ntr avenous fl ui ds i n mul ti pl e pr egnancy. Twin Research (2000) 3, 113-117.Keyw or ds: pregnancy compl i cati on, mul ti pl e gestati on, monochori oni c tw i ns, tw i n-to-tw i n transfusi on syndrome, pol yhydramni os, hypoprotei nemi a, anemi a, col l oi d osmoti c pressure

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Section: Introductionmentioning

confidence: 99%

Maternal metabolic abnormalities in twin–to–twin transfusion syndrome at mid–pregnancy

Lia

Kuhlmann²,

Emery³

2000

twin res

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“…The amniotic fluid volume increased acutely in only one oligohydramnic sac after decompression, and ultrasonographic examination, amniotic fluid spectrophotometric analysis, and placental pathologic examination all identified interfetal membrane disruption as the etiology. Conclusions: Decompression amniocentesis as a treatment for TOPS does not result in acute or chronic changes in the amniotic fluid volume of the oligohydramnic sac in the absence of interfetal membrane disruption.The twin oligohydramnios-polyhydramnios sequence (TOPS) is identified antenatally by ultrasonographic findings of marked growth discordance, coexistent oligohydramnios and polyhydramnios, a monochorionic placenta, and same-sex fetuses [1]. Alhtough many cases are caused by the twin-to-twin transfusion syndrome, other etiologies have also been reported.…”

mentioning

confidence: 99%

Equalization of Amniotic Fluid Volumes after Decompression Amniocentesis for Treatment of the Twin Oligohydramnios-Polyhydramnios Sequence

Bruner

Crean²

1999

Fetal Diagn Ther

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Objective: To measure acute and chronic changes in the placenta and amniotic fluid associated with performance of decompression amniocentesis in pregnancies with the twin oligohydramnios-polyhydramnios sequence (TOPS). Methods: Amniotic fluid pressures, placental thickness, placental perfusion, and amniotic fluid volumes were measured in each sac of a monochorionic diamniotic twin gestation before and after decompression amniocentesis. Indigo carmine was injected into the polyhydramnic sac after decompression, and fluid from the oligohydramnic sac was sampled after equilibration. Spectrophotometric analysis of amniotic fluid specimens was performed for dye detection. Amniotic fluid volume and placental perfusion studies were repeated 1 week later. Results: Three patients with TOPS were enrolled, and decompression amniocentesis was performed in the midtrimester. After decompression, amniotic fluid volume decreased in the polyhydramnic sac, amniotic fluid pressures decreased in both sacs, placental thickness increased, and umbilical artery Doppler velocimetry was unaffected. The amniotic fluid volume increased acutely in only one oligohydramnic sac after decompression, and ultrasonographic examination, amniotic fluid spectrophotometric analysis, and placental pathologic examination all identified interfetal membrane disruption as the etiology. Conclusions: Decompression amniocentesis as a treatment for TOPS does not result in acute or chronic changes in the amniotic fluid volume of the oligohydramnic sac in the absence of interfetal membrane disruption.

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“…Ovo se može isključiti ako su plodovi različitog pola ili nakon porođaja, histopatološkom analizom posteljice. Druga stanja koja mogu da dođu u obzir su: TORCH infekcije ograničene na jednom blizancu, asimetrični horionski razvoj, mirror sindrom [37], fetomaternalna hemoragija, abrupcija, agenezija duktusa venozusa i bilateralna renalna agenezija jednog ploda [22,23].…”

Section: Diferencijalna Dijagnozaunclassified

Pathophysiology of twin to twin transfuzion syndrome

Sulovic¹,

Marjanovic²,

Sulovic³

2014

Praxis Med

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1 Klinika za Ginekologiju i Akušerstvo -Medicinski fakultet, Univerziteta u Prištini 1 Klinika za Pedijatriju -Medicinski fakultet, Univerziteta u Prištini Twin to twin transfusion sindrom (TTTTS) je patološko stanje gde blizanac donor "krvari" u cirkulaciju fetusa recipijenta preko abnormalnih interblizanačkim placentnih anastomoza. Blizanac donor postaje anemičan, hipovolemičan, zaostaje u rastu i kao posledicu ima smanjenu urinarnu produkciju. Kako funkcija gutanja amnionske tečnosti nije oštećena, volumen plodove vode se progresivno smanjuje. Blizanac recipijent postaje hipervolemičan i policitemičan. Višak cirkulišuće krvi i nemogućnost adekvatne eliminacije nekada može da dovede do pojave hidropsa u težim slučajevima. Povećana urinarna produkcija recipijenta vodi pojavi polihidroamniona i prekomernoj distenziji amnionskog kavuma, kompresije i smanjnje perfuzije donora. Redukcija amnionske tečnosti kod donora rezultuje fiksacijom donora uz zid uterusa (najčešće prednji zid), (Slika 1.) (stanje nazvano stuck twin) 1,36.Ključne reči: trudnoća, blizanci, zigocitet, horionicitet, placentni poremećaji, ultrazvuk, TTTTS, fetalni kardioločki poremećaji, pridruženi sindromi UVOD PATOFIZIOLOGIJA TTTTS -ANATOMSKA OSNOVA Već je rečeno da patofiziologija TTTTS nije u potpunosti jasna, uglavnom zbog toga što ne postoji odgovarajući animalni model, a humani fetus nije lako dostupan za invazivni monitoring, ili radiološka ispitivanja. Ex-vivo studije sa injiciranim bojama, pokazale su da skoro sve monohorionaske (MC) placente imaju vaskularne anastomoze [2]. Zbog toga je interblizanačka transfuzija praktično standardna u MC trudnoćama. Ovo je potvrđeno u in-vivo studijama ispitivanjima markera kao što su eritrociti, pankuronijum i kontrasni agensi, koji su ubrizgani jednom blizancu, da bi prošli u drugog [3]. Postoje tri tipa placentalnih anastomoza: arterio-arterijske (AAA), veno-venske (VVA) i arterio-venske (AVA). Razlikovanje ovih anastomoza moguće je samo makroskopski, praćen-jem u nazad ovih krvnih sudova, sve do insercije pupčanika, a arterije obične leže povrh placentnih vena. Zona susreta dve cirkulacije zove se vascular equator i mada je ovo spoj placentnih diskova, nije uvek na sredini zajedničke mase, a međublizanačke membrane ne leže uvek preko ove površine, već mogu biti na bilo kojoj strani. Očekuje se da se anastomoze vide na vaskularnom ekvatoru. Arterio-arterijske i veno-venske su površne anastomoze, koje se u celini pružaju duž horionske ploče. One su sposobne za bidirekcioni protok, zavisno od promena u inače sličnim osnovnim hidrostatskim pritiscima. Za razliku od njih, duboke arterio-venske anastomoze posreduju unidirekcioni protok od jednog blizanca do drugog, ali nisu striktne anastomoze, jer ne bajpasiraju (do not bypass) kapilarnu cirkulaciju. Arterija jednog blizanca ulazi u placentalni kotiledon horionske ploče i formira uobičajeno vilusno kapilarno ležište, ali korespondirajuća vena, koja se nalazi blizu arterije, drenira se u drugog blizanca. Arterio-venske anastomoze su prisutne kod gotovo s...

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Twin-to-twin transfusion syndrome: A subset of the twin oligohydramnios-polyhydramnios sequence

Cited by 72 publications

References 21 publications

Maternal metabolic abnormalities in twin–to–twin transfusion syndrome at mid–pregnancy

Maternal metabolic abnormalities in twin–to–twin transfusion syndrome at mid–pregnancy

Equalization of Amniotic Fluid Volumes after Decompression Amniocentesis for Treatment of the Twin Oligohydramnios-Polyhydramnios Sequence

Pathophysiology of twin to twin transfuzion syndrome

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