Twin-twin transfusion syndrome: etiology, severity and rational management

Current Opinion in Obstetrics & Gynecology
M J van GemertM G Ross

Abstract

The twin-twin transfusion syndrome is a serious complication of monochorionic twin pregnancies. Partly as a result of an inadequate understanding of the pathophysiology of the syndrome, there is a lack of consensus in clinical management. We sought to review the available information on the etiology of twin-twin transfusion syndrome, to identify parameters that contribute to the severity of the syndrome, and propose a rational management plan based on pathophysiology, clinical presentation and the efficacy of therapies. We therefore amalgamated recent advances in twin-twin transfusion syndrome computer modelling and clinical studies, particularly on therapeutic outcomes. We found that the oligo-polyhydramnios sequence that defines twin-twin transfusion syndrome prenatally represents a wide continuum of severity in the imbalance between the fetoplacental circulations of both twins. In severe twin-twin transfusion syndrome cases, in which the circulatory imbalance deteriorates beyond fetal control, fetoscopic laser therapy of all anastomoses along the placental vascular equator is predicted to have significantly better survival rates and fewer neurological sequelae than amnioreduction. In contrast, mild twin-twin transfusion synd...Continue Reading

References

Mar 1, 1992·American Journal of Obstetrics and Gynecology·N J SaundersK H Nicolaides
Nov 1, 1990·American Journal of Obstetrics and Gynecology·B S MahonyJ H Hirsch
Nov 1, 1990·American Journal of Obstetrics and Gynecology·M A UrigJ P Elliott
Jan 1, 1990·Acta Obstetricia Et Gynecologica Scandinavica·A Rådestad, P A Thomassen
Aug 1, 1990·The Australian & New Zealand Journal of Obstetrics & Gynaecology·L H SteinbergN A Beischer
Aug 1, 1995·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·S SharmaS Shen-Schwarz
Aug 10, 1995·The New England Journal of Medicine·B Williams
Sep 28, 1995·The New England Journal of Medicine·M W Elliott
Apr 1, 1995·American Journal of Obstetrics and Gynecology·J E De LiaD P Cruikshank
Feb 1, 1995·The Australian & New Zealand Journal of Obstetrics & Gynaecology·J E Dickinson
Feb 1, 1995·The Australian & New Zealand Journal of Obstetrics & Gynaecology·S MeagherB Susil
Jan 26, 1995·The New England Journal of Medicine·Y VilleK Nicolaides
Sep 1, 1994·Fetal Diagnosis and Therapy·C P Weiner, A Ludomirski
Mar 1, 1995·American Journal of Obstetrics and Gynecology·R BajoriaN M Fisk
Oct 1, 1993·American Journal of Obstetrics and Gynecology·J P Bruner, R L Rosemond
Oct 1, 1993·American Journal of Obstetrics and Gynecology·D P ReisnerD A Luthy
Sep 1, 1993·Placenta·J E De LiaL R O'Bee
Aug 1, 1996·The Australian & New Zealand Journal of Obstetrics & Gynaecology·R CincottaA Sampson
Aug 1, 1997·American Journal of Obstetrics and Gynecology·L G Dennis, C L Winkler
May 1, 1997·Fetal Diagnosis and Therapy·J DeprestB J Hackeloër
Dec 24, 1997·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine·T L Cook, R O'Shaughnessy
Apr 16, 1998·American Journal of Obstetrics and Gynecology·M L DenbowN M Fisk
May 8, 1998·Obstetrics and Gynecology·D M FeldmanJ F Rodis
May 30, 1998·European Journal of Obstetrics, Gynecology, and Reproductive Biology·M J van GemertS A Scherjon
Jun 3, 1998·British Journal of Obstetrics and Gynaecology·Y VilleK Nicolaides
Jun 30, 1998·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·N J SebireK H Nicolaides
Jul 3, 1998·Fetal Diagnosis and Therapy·G R SaadeK J Moise
Oct 28, 1998·American Journal of Obstetrics and Gynecology·V FesslovaU Nicolini
Dec 29, 1998·Current Opinion in Obstetrics & Gynecology·K A Filkins, S E Beverly
Mar 17, 1999·American Journal of Obstetrics and Gynecology·K HecherB J Hackelöer
Mar 23, 1999·Fetal Diagnosis and Therapy·S SuzukiT Araki
Apr 21, 1999·Prenatal Diagnosis·I Branisteanu-DumitrascuR Pijnenborg
Jan 25, 2000·Journal of Perinatology : Official Journal of the California Perinatal Association·R A QuinteroM Kruger
Feb 5, 2000·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·L ZikulnigB J Hackelöer
Mar 30, 2000·American Journal of Obstetrics and Gynecology·J E Dickinson, S F Evans
Jun 22, 2000·The New England Journal of Medicine·J ConcatoR I Horwitz
Aug 25, 2000·Physics in Medicine and Biology·M J van Gemert, A Umur
Sep 15, 2000·European Journal of Obstetrics, Gynecology, and Reproductive Biology·K HecherB J Hackelöer
Sep 15, 2000·European Journal of Obstetrics, Gynecology, and Reproductive Biology·C HubinontJ Donnez

❮ Previous
Next ❯

Citations

May 10, 2003·Obstetrics and Gynecology·Wing Cheong LeungT T Lao
Mar 22, 2003·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Tiziana FruscaPaola Martelli
Mar 24, 2004·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Rekha BajoriaSuren R Sooranna
Sep 16, 2003·Ultrasound Quarterly·Vickie A Feldstein
Apr 8, 2006·Fetal Diagnosis and Therapy·Charles H RodeckEric Jauniaux
Jan 18, 2007·Fetal Diagnosis and Therapy·J M MiddeldorpF P H A Vandenbussche
Apr 27, 2013·Pediatric and Developmental Pathology : the Official Journal of the Society for Pediatric Pathology and the Paediatric Pathology Society·Monique E De Paepe, Francois I Luks
Nov 11, 2005·Journal of Perinatology : Official Journal of the California Perinatal Association·Leandro CorderoRichard W O'shaughnessy
Dec 23, 2015·Birth Defects Research. Part A, Clinical and Molecular Teratology·Martin J C van GemertPeter G J Nikkels
Feb 10, 2010·Journal de gynécologie, obstétrique et biologie de la reproduction·J Stirnemann
Feb 17, 2007·Placenta·M H BeallM G Ross
Dec 6, 2005·Clinics in Perinatology·Anita Szwast, Jack Rychik
Sep 24, 2005·The Journal of Obstetrics and Gynaecology Research·Akiko HayashiNobuya Unno
Mar 17, 2007·Annals of the New York Academy of Sciences·Jeroen P H M VAN DEN WijngaardMartin J C VAN Gemert
May 23, 2007·BJOG : an International Journal of Obstetrics and Gynaecology·J M MiddeldorpD Oepkes
May 23, 2007·BJOG : an International Journal of Obstetrics and Gynaecology·A M IerulloB Thilaganathan
Jul 29, 2004·Best Practice & Research. Clinical Obstetrics & Gynaecology·Agnes Huber, Kurt Hecher
Jul 28, 2004·Pediatric Clinics of North America·Matthew J BizzarroRichard A Ehrenkranz
Mar 10, 2007·American Journal of Obstetrics and Gynecology·Enrico LoprioreFrans J Walther
Mar 25, 2009·American Journal of Obstetrics and Gynecology·Enrico LoprioreFrank P Vandenbussche
Jul 25, 2009·American Journal of Obstetrics and Gynecology·Marise M WagnerJohanna M Middeldorp
Dec 6, 2005·American Journal of Obstetrics and Gynecology·Jeroen P H M van den WijngaardMartin J C van Gemert
Nov 25, 2003·American Journal of Obstetrics and Gynecology·Asli UmurPeter G J Nikkels
Mar 19, 2016·Prenatal Diagnosis·Ellen HinchAlec W Welsh
Aug 6, 2003·Radiologic Clinics of North America·Vickie A Feldstein, Roy A Filly
Apr 24, 2004·Physics in Medicine and Biology·Jeroen P H M van den WijngaardMartin J C van Gemert
Dec 2, 2004·Obstetrics and Gynecology·Samawal LutfiMichael J Vincer
Dec 23, 2006·Prenatal Diagnosis·Jeroen P H M van den WijngaardMartin J C van Gemert
May 30, 2007·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·A SzwastJ Rychik
Nov 17, 2007·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·K O'DonoghueN M Fisk
Mar 12, 2008·Prenatal Diagnosis·Jeroen P H M van den WijngaardMartin J C van Gemert
Sep 20, 2005·Prenatal Diagnosis·Paula GaleaNicholas M Fisk
Sep 20, 2005·Prenatal Diagnosis·R RobyrY Ville
Jun 17, 2006·American Journal of Physiology. Regulatory, Integrative and Comparative Physiology·Jeroen P H M van den WijngaardMartin J C van Gemert
Dec 13, 2006·American Journal of Physiology. Regulatory, Integrative and Comparative Physiology·Jeroen P H M van den WijngaardMartin J C van Gemert
Mar 21, 2008·Physics in Medicine and Biology·Martin J C van GemertFrank P H A Vandenbussche
Nov 13, 2004·American Journal of Physiology. Regulatory, Integrative and Comparative Physiology·Jeroen P H M van den WijngaardMartin J C van Gemert
Aug 17, 2019·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Yong Hee ParkMoon Su Sung

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