Twin-to-twin transfusion syndrome: Prenatal diagnosis and treatment

Richard M. Benoit, Ahmet Baschat

Research output: Contribution to journalArticle

Abstract

Clinical Problem Twin-to-twin transfusion syndrome (TTTS) increases perinatal morbidity and mortality for 10 to 15% of monochorionic (MC) gestations. Pathophysiology MC gestations are at risk due to the angioarchitecture of the shared placenta, with anastomoses of varying type, size, and quantity. TTTS results from progression of a chronic perfusion imbalance across unbalanced placental anastomoses, typically arising between 15 and 26 weeks gestation. The resulting abnormal fetal blood volume levels and compensatory physiological responses lead to an increased risk for fetal death, end-organ damage, and preterm birth. Prenatal Diagnosis Surveillance with ultrasound is essential for detection and treatment. TTTS is diagnosed once polyhydramnios occurs in the recipient (maximal vertical fluid pocket [MVP] > 8 cm) and oligohydramnios in the donor (MVP <2 cm). The Quintero et al method is commonly used for staging, utilizing the presence or absence of donor bladder filling, abnormal fetal Doppler values, fetal hydrops, and demise. Treatment Fetoscopic laser photocoagulation of placental anastomoses is an effective treatment addressing the underlying pathophysiology. Further research is needed to improve survival rates, reduce risks of fetoscopy, and gain understanding of the prediction, assessment, and optimization of long-term outcomes for TTTS survivors.

Original languageEnglish (US)
Pages (from-to)583-594
Number of pages12
JournalAmerican Journal of Perinatology
Volume31
Issue number7
DOIs
StatePublished - 2014
Externally publishedYes

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Fetofetal Transfusion
Prenatal Diagnosis
Fetal Death
Pregnancy
Fetoscopy
Tissue Donors
Oligohydramnios
Polyhydramnios
Hydrops Fetalis
Light Coagulation
Perinatal Mortality
Premature Birth
Therapeutics
Blood Volume
Fetal Blood
Placenta
Survivors
Urinary Bladder
Lasers
Survival Rate

Keywords

  • fetoscopy
  • laser ablation
  • monochorionic twins
  • prenatal diagnosis
  • twin-to-twin transfusion syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Twin-to-twin transfusion syndrome : Prenatal diagnosis and treatment. / Benoit, Richard M.; Baschat, Ahmet.

In: American Journal of Perinatology, Vol. 31, No. 7, 2014, p. 583-594.

Research output: Contribution to journalArticle

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