Long term outcome of twin-twin transfusion syndrome

Abstract

Aims-To compare the perinatal mortality and morbidity of infants with twintwin transfusion syndrome (TTTS) with those of gestation matched twin controls and to assess the neurodevelopmental outcome of surviving twins with TTTS. Methods-A cohort of 17 consecutive pregnancies with TTTS was enrolled over three years together with gestation matched twin pregnancies unaVected by TTTS. Serial amnioreduction for the TTTS pregnancies was performed as appropriate. Perinatal death and neonatal morbidities were recorded for both the TTTS cohort and controls. The TTTS survivors had neurodevelopmental follow up to at least 2 years of age. Results-In 12 of the pregnancies, serial amniocenteses were performed, but, in five, the infants were born before intervention. The mean gestational age at delivery was 29.1 weeks (range 23-36). There were five intrauterine deaths in the TTTS cohort and six neonatal deaths (survival 68%). In the control group, there was one intrauterine death and five neonatal deaths (survival 82%). Infants in the TTTS group had a greater requirement for inotropes (p = 0.04) and a higher incidence of renal failure (p = 0.005). Periventricular leucomalacia and cerebral atrophy were seen in 17% of the TTTS group, but none of the controls (p = 0.03). The 23 surviving TTTS infants were all followed up, with 22% having significant neurological morbidity: cerebral palsy and global developmental delay. Conclusions-Twins with TTTS have high perinatal mortality and neonatal morbidity, and long term neurodevelopmental morbidity in survivors is high. Further investigation into the pathogenesis and management of TTTS is required. (Arch Dis Child Fetal Neonatal Ed 2000;83:F171-F176)

Blood pressures in newborns with twin–twin transfusion syndrome

“…Incidence of renal function impairment is higher in TTTS than in non-TTTS twins. 40 In our cohort, the incidence of impaired renal function is similar between donors and recipients as reported by some 40 but not all studies, which rather indicate a higher proportion of donors affected. 12 Donor kidneys present tubular dysgenesis and ischemic glomerules compatible with chronic hypoperfusion whereas lesions in recipients are compatible with hypertensive glomerulopathies; 9,41,42 renal histopathology data were not available in this study.…”

Perinatal Outcomes With Laser Surgery for Twin–Twin Transfusion Syndrome

“…Untreated, the literature indicates that less than 20% survive when delivery occurs at less than 28 weeks' gestation (Gul et al, 2003). Amnioreduction for TTTS has been employed for some years with survival rates of 50% to 70% being most commonly reported (Cincotta et al, 2000;Dickinson & Evans, 2000;Johnsen et al, 2004;Lopriore et al, 2003). More recently laser ablation of the placental communicating vessels has been advocated as the preferred treatment for this condition, though overall survival rates have not been shown to be markedly improved (De Lia et al, 1995;Hecher et al, 2000;Quintero et al, 2003;Senat et al, 2004;Ville et al, 1995).…”

Current Treatment of Twin-to-Twin Transfusion Syndrome

“…Так как сосудистые анастомозы продолжают функционировать, физиологический стресс у плодов сохраняется, что клинически под-тверждается высокой неонатальной смертностью среди выживших плодов. Данные отдаленных исходов развития нервной системы при лечении ФФТС методом амниоредукции показывают часто-ту церебрального паралича 5,8-22,5% и задержку развития 7,5-22,5% [21,22,23]. В связи с этим в на-стоящее время амниоредукция считается методом выбора только при I стадии ФФТС или при сроке беременности более 24 недель, когда выполнение ФЛК технически может быть затруднено в связи с высоким риском развития кровотечения из коагу-лируемых анастомозов большого диаметра.…”

“…Исследования, посвященные неврологическим последствиям при применении лазерной терапии, выявили меньшую частоту повреждений головного мозга, с частотой не более 5%. Следует отметить, что почти 70% ро-дов в этой группе произошло при сроке беременно-сти более 32 недель [21,22,23,24,25].…”