Twin-to-twin transfusion syndrome neurodevelopmental follow-up study (neurodevelopmental outcomes for children whose twin-to-twin transfusion syndrome was treated with placental laser photocoagulation)

Abstract

BackgroundTwin-to-twin transfusion syndrome (TTTS) is a serious complication of 10–15% of twin or triplet pregnancies in which multiple fetuses share a single placenta. Communicating placental vessels allow one fetus (the donor) to pump blood to the other (the recipient). Mortality rates without intervention are high, approaching 100% in some series, with fetal deaths usually due to cardiac failure. Surgical correction using laser photocoagulation of communicating placental vessels was developed in the 1980s and refined in the 1990s. Since it was introduced in Victoria in 2006, laser surgery has been performed in approximately 120 pregnancies.Survival of one or more fetuses following laser surgery is currently > 90%, however the neurodevelopmental outcomes for survivors remain incompletely understood. Prior to laser therapy, at least one in five survivors of TTTS had serious adverse neurodevelopmental outcomes (usually cerebral palsy). Current estimates of neurological impairment among survivors following laser surgery vary from 4 to 31% and long-term follow-up data are limited.MethodsThis paper describes the methodology for a retrospective cohort study in which children aged 24 months and over (corrected for prematurity), who were treated with laser placental photocoagulation for TTTS at Monash Health in Victoria, Australia, will undergo comprehensive neurodevelopmental assessment by a multidisciplinary team. Evaluation will include parental completion of pre-assessment questionnaires of social and behavioural development, a standardised medical assessment by a developmental paediatrician or paediatric neurologist, and age-appropriate cognitive and academic, speech and fine and gross motor assessments by psychologists, speech and occupational therapists or physiotherapists. Assessments will be undertaken at the Murdoch Children’s Research Institute/Royal Children’s Hospital, at Monash Health or at another mutually agreed location. Results will be recorded in a secure online database which will facilitate future related research.DiscussionThis will be the first study to report and evaluate neurodevelopmental outcomes following laser surgery for twin-to-twin transfusion syndrome in Victoria, and will inform clinical practice regarding follow-up of children at risk of adverse outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1230-8) contains supplementary material, which is available to authorized users.

Inter-foetus Membrane Segmentation for TTTS Using Adversarial Networks

“…Twin-to-Twin Transfusion Syndrome (TTTS) is a pathology with deadly consequences that occurs in the 15% of monochorionic pregnancies (75% of twin homozygous pregnancies) 3 .…”

Twin-to-Twin Transfusion Syndrome: Diagnostic Imaging and Its Role in Staving Off Malpractice Charges and Litigation

“…Prior to laser therapy, at least one in five survivors of TTTS had serious adverse neurodevelopmental outcomes (usually cerebral palsy). Neurological impairment among survivors following laser surgery is currently estimated to range from 4 to 31%, although long-term follow-up data are still limited [ 31 ]. Scientific evidence exists proving the superiority of fetoscopic laser ablation over serial amnioreductions regarding survival and neurological outcome for stages II–IV TTTS [ 32 ].…”

Perioperative Care of Patients Diagnosed With Twin‐to‐Twin Transfusion Syndrome Undergoing Laparoscopic‐Assisted Fetoscopic Placental Laser Photocoagulation

“…Not all monochorionic diamniotic pregnancies result in TTTS; however, the majority of TTTS occurrences involve vascular anastomoses connecting the circulation between the two fetuses 7 . Fetuses affected with this syndrome are identified according to their role in the disease: one twin (the donor) pumps blood to the other twin (the recipient) 8 . As the condition progresses, the donor twin and amniotic sac shrink, ultimately tightly encasing the donor twin.…”

“…The reduction in fluid occurs because of the donor twin’s decreased blood circulation and decreased production of amniotic fluid. In contrast, the recipient twin and amniotic sac expand because of the increased blood flow and increased production of amniotic fluid 8 …”

“…Fetal mortality ranges from 70% to 100% in untreated severe TTTS, 7 and most in utero fetal deaths are the result of in utero cardiac failure from the disproportionate supply of blood between the twins 8 . Untreated TTTS also results in polyhydramnios (ie, high volumes of amniotic fluid) from the recipient twin’s increased urine production, as well as an increased incidence of the premature rupture of membranes and preterm delivery.…”