Twin to twin transfusion syndrome (TTTTS) accounts for approximately 10% of monochorionic twin pregnancies and, if left untreated, is associated with high morbidity and mortality rate. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been supposed as the major etiology of TTTTS. The donor twin becomes hypovolemic and oliguria, oligohydramnios, and a variable degree of growth restriction develop, whereas the recipient twin manifests polyuria, polyhydramnios, and hydrops in response to hypervolemia. TTTTS can be treated by either serial amniocentesis or selective fetoscopic laser coagulation of the communicating vessels. The rationale for removal of large volumes of amniotic fluid is to prevent preterm delivery secondary to polyhydramnios and to improve fetal circulation by reducing pressure on the chorionic plate. On the other hand, the goal of laser therapy is to occlude vascular anastomoses, thereby interrupting intertwin blood exchange. Although laser treatment is associated with increased survival rate and reduced neurologic complications, compared with amnioreduction, it requires highly specialized centers, whereas serial amniocentesis has the advantage of being performed worldwide. Therefore, the optimal treatment for pregnancies complicated with TTTTS is still controversial.
Hecher K, Plath H, Bregenzer T, Hansmann M, Hackeloer B. Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome. Am J Obstet Gynecol. 1999;717–24.
2.
Senat M, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;136–44.
3.
Blickstein I, Keith G. Multiple pregnancy 2nd edition; Epidemiology, Gestation and Perinatal outcome. Informa Healthcare. 2006;
4.
Šulovic N, Dunjić M, Stanisic S, Lj S. Abnormality of twin pregnancy: fetus papyraceus -case raport. 2000;
5.
Salomon L, Ville Y. Twin-to-twin transfusion syndrome: diagnosis and treatment. Bull Acad Natl Med. 2008;(8):1575–86.
6.
Šulović N. 2011;
7.
Chiossi G, Quigley M, Esaka E, Novic K, Celebrezze J, Golde S. Nutritional supplementation in monochorionic diamniotic twin pregnancies: impact on twin-twin transfusion syndrome. Am J Perinatol. 2008;(10):667–72.
8.
Rossi A, V. Diagnosis and management of Twin-Twin transfusion syndrome. Minerva Ginecol. 2009;(2):153–65.
9.
Cincotta R, Gray P, Gardener G, Soong B, Chan F. Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin-twin transfusion syndrome. Aust N Z J Obstet Gynaecol. 2009;(1):22–7.
10.
Baschat A, Barber J, Pedersen N, Turan O, Harman C. Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2013;
11.
Evidence B, Fox ], Kilby C, Khan M, K. Contemporary treatments for twin-twin transfusion syndrome. Obstet Gynecol. 2005;(6):1469–77.
12.
De Lia J, Emery M, Sheafor S. Twin transfusion syndrome: successful in utero treatment with digoxin. Int J Gynaecol Obstet. 1985;197–201.
13.
Kontic-Vucinic O, Sulovic N, Radunovic N. Twin to twin transfusion syndrome -our expirience in treatment by amniodrainage and amniotic septostomy. XIX European Congress of Perinatal and Neonatal Medicine. 2004;
14.
Kontic-Vucnic O, Radunovic N, Sulovic N, Bratic D, Mitrovic M, Pilic I. Treatment of twin to twin transfusion syndrome by amniodrainage and amniotic septostomy. The fetus as a patient. 2005;
15.
Trespidi L, Boschetto C, Caravelli E, Villa L, Kustermann A, Nicolini U. Serial amniocentesis in the management of twin-twin transfusion syndrome: When is it valuable? Fetal Diagn Ther. 1997;15–20.
16.
Saade G, Belfort M, Berry D. Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence. Fetal Diagn Ther. 1998;86–93.
17.
Johnson J, Rossi K, Shaughnessy O, R. Amnioreduction versus septostomy in twin-twin syndrome. Am J Obstet Gynecol. 2001;1044–7.
18.
Saade G, Droman M, K. A randomized trial od septostomy versus amnioreduction in the treatment of twin oligohydramnios polyhydramnios sequence (tops). Am J Obstet Gynecol. 2003;
19.
Ville Y, Hecher K, Gagnon A. Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome. Br J Obstet Gynecol. 1998;446–53.
20.
Lia D, Kuhlmann J, Lopez R, K. Treating previable twin-twin transfusion syndrome with feroscopic laser surgery: outcomes following the learning curve. J Perinatal Med. 1999;61–7.
21.
Quintero R, Dickinson J, Morales W. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;13333–11340.
22.
Hecher K, Diehl W, Zikulnig L. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe midtrimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol. 2000;135–9.
23.
Sutcliffe A, Sebire N, Pigott A. Outcome for children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome. Br J Obstet Gynecol. 2001;1246–50.
24.
Middeldorp J, Lopriore E, Sueters M. Twin-to-twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery? BJOG. 2007;(6):694–8.
25.
Ilagan J, Wilson R, Bebbington M, Johnson M, Hedrick H, Liechty K, et al. Pregnancy outcomes following bipolar umbilical cord cauterization for selective termination in complicated monochorionic multiple gestations. Fetal Diagn Ther. 2008;(2):153–8.
26.
Rossi A, D’addario V. Umbilical cord occlusion for selective feticide in complicated monochorionic twins: a systematic review of literature. Am J Obstet Gynecol. 2009;(2):123–9.
27.
Beck V, Lewi P, Gucciardo L, Devlieger R. Preterm prelabor rupture of membranes and fetal survival after minimally invasive fetal surgery: a systematic review of the literature. Fetal Diagn Ther. 2012;(1):1–9.
28.
O’Donoghue K, Rutherford M, Engineer N, Wimalasundera R, Cowan F, Fisk N. Transfusional fetal complications after single intrauterine death in monochorionic multiple pregnancy are reduced but not prevented by vascular occlusion. BJOG: An International Journal of Obstetrics & Gynaecology. 2009;116(6):804–12.
29.
Mitrović M, Kontić O, Šulović N, Radunović N. Nadzor trigemine trudnoće -komlikacije i ishodi -prikaz pet slučaja. Novine u perinatalnoj medicini. 2004;
30.
Roberts D, Gates S, Kilby M, Neilson J. Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol. 2008;701–11.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
