Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome

Mieghem, Tim Van; Doné, Elisa; Gucciardo, Léonardo; Klaritsch, Philipp; Allegaert, Karel; Bree, Rieta Van; Lewi, Liesbeth; Deprest, Jan

doi:10.1016/j.ajog.2009.08.013

Cited by 59 publications

(83 citation statements)

References 30 publications

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“…TTTS is a severe hemodynamic disorder which leads to a progressive sequence characterized by hypovolemia, oliguria, and oligohydramnios in the donor, and hypervolemia, polyuria, and polyhydramnios in the recipient [26,27]. Additionally, release of vasoactive substances and sustained oliguria lead to hypertension and renal tubular damage in the donor, while transfer of these substances to the recipient is thought to produce hypertension and contribute further to hypertrophic cardiomyopathy [28,29,30]. Irrespective of the complex pathophysiology underlying this syndrome, there is universal agreement that TTTS is invariably associated with massive changes in fetal diuresis that lead to very obvious differences in AF deepest pocket and bladder size.…”

Section: Chronic Feto-fetal Transfusion Syndromes: Ttts and Tapsmentioning

confidence: 99%

A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies

2012

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Monochorionic (MC) twins represent a significant proportion of perinatal morbidity and mortality. Overall, 1 of 3 MC twin pregnancies will develop complications in relation to the MC placenta and the presence of interfetal placental anastomoses. From a clinical standpoint, these complications can be grouped into four main types of clinical problems: chronic transfusion, acute transfusion, growth discordance, and discordant malformation. Differential diagnosis of MC twin complications is still challenging due to frequent overlap of their clinical signs and the complex relationships between them. Clinical experience demonstrates that most instances of wrong management derive from failure to comply with a basic set of rules for diagnosis and management. In this review, we propose a simplified approach to the understanding of MC twin pregnancy, its potential complications, and the key concepts allowing adequate differential diagnosis and targeted management.

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Section: Chronic Feto-fetal Transfusion Syndromes: Ttts and Tapsmentioning

confidence: 99%

A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies

2012

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“…10 The natriuretic peptide systems have been shown to be activated in monochorionic diamniotic (MD) twins with twinto-twin transfusion syndrome (TTTS), and they have an important role in the appearance of clinical manifestations. 11,12 Recently, a positive correlation between amniotic fluid levels of brain-type natriuretic peptide and recipient cardiomyopathy in TTTS was reported. 13 We previously reported that serum NT-proBNP levels at birth were significantly lower in TTTS patients with fetoscopic laser photocoagulation (FLP) treatment than in those without FLP treatment.…”

Section: Introductionmentioning

confidence: 99%

N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction

et al. 2013

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“…Bajoria et al 8 showed high concentrations of hANP in the cord blood of recipient (larger) twins of TTTS. Van Mieghem et al 9 showed that BNP levels are increased in the amniotic fluid of recipient twins of TTTS. Therefore, as larger TTTS twins might have high levels of hANP and BNP, we compared hANP and BNP levels between smaller and larger MD twins.…”

Section: Discussionmentioning

confidence: 99%

“…5 The RAA and NP systems have been shown to be activated in MD twins with TTTS and they have an important role in the appearance of clinical manifestations. [6][7][8][9] This phenomenon has resulted in determining obstetric interventions for TTTS in MD twins. 8,10 The activation levels of the RAA and NP systems in MD twins before development of TTTS need to be determined.…”

Section: Introductionmentioning

confidence: 99%

Renin is activated in monochorionic diamniotic twins with birthweight discordance who do not have twin-to-twin transfusion syndrome

et al. 2011

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Objective: To assess renin, aldosterone, human atrial natriuretic peptide (hANP) and brain natriuretic peptide (BNP) levels in cord blood from monochorionic diamniotic (MD) twins with a birthweight (BW) discordance that do not satisfy the criteria of twin-to-twin transfusion syndrome (TTTS).Study Design: Cord blood samples were obtained from 28 MD twins without TTTS. They were divided into two groups on the basis of BW discordance as follows: large (>7.5%) and small (p7.5%). Cord blood renin, aldosterone, hANP and BNP levels were measured.Result: Renin levels in MD twins with a large BW discordance were significantly higher than those in MD twins with a small BW discordance, with no significant differences in aldosterone, hANP and BNP levels. A significant correlation was found between renin levels and BW discordance. Conclusion:Renin is activated in MD twins with a BW discordance of >7.5%, even in non-TTTS.

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Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome

Cited by 59 publications

References 30 publications

A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies

A Systematic Approach to the Differential Diagnosis and Management of the Complications of Monochorionic Twin Pregnancies

N-terminal pro-brain natriuretic peptide levels in monochorionic diamniotic twins with selective intrauterine growth restriction

Renin is activated in monochorionic diamniotic twins with birthweight discordance who do not have twin-to-twin transfusion syndrome

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