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

Gemert, M.J. van; Umur, Asli; Tijssen, Jan G.P.; Ross, Michael G.

doi:10.1097/00001703-200104000-00015

Cited by 103 publications

(60 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…= polyhydramnios; ND = no decision: both trends correlated equally well; AR = amnioreduction; sept. = unintentional septostomy. 1 Before laser treatment. 2 After thrombosis of a major chorionic vein [19].…”

Section: Resultsmentioning

confidence: 99%

“…In spite of that, before steady state onset, there is feto-fetal transfusion, which may create an intertwin weight difference. However, once steady state evolves, weight difference develops proportional to the average of the two weights, implying the DAR remains constant, although it can occasionally be large [1,2,9]. We acknowledge that strong inter-twin discordance is a general risk factor in twin pregnancies [10].…”

Section: Introductionmentioning

confidence: 85%

“…Of TTTS cases treated by fetoscopic laser therapy, only data before treatment were included, since laser therapy modifies the placental angio-architecture and, hence, the natural history of the pregnancy. We included the data during and following amnioreduction and unintentional septostomy, because these interventions only marginally change the natural history of the pregnancy [1,4]. We tested whether the discordant clinical fetal growth patterns correlated with the previously derived algebraic relations (table 2) for TTTS and non-TTTS pregnancies.…”

Section: Methodsmentioning

confidence: 99%

“…Classification of TTTS and non-TTTS, their clinical presentations, staging of TTTS severity [7], their DAR behaviour, and degree of imbalance between the two feto-placental circulations net feto-fetal transfusion from the donor to the recipient. TTTS is associated with significant mortality and morbidity [1].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Discordant Fetal Growth Patterns in Monochorionic Twin Pregnancies Described by Simple Algebraic Relations

Umur

Gemert²,

Schaap³

et al. 2003

Fetal Diagn Ther

Self Cite

View full text Add to dashboard Cite

Objective: To test whether twin-twin transfusion syndrome (TTTS) and non-TTTS cases that were suspect but not confirmatory for developing the syndrome (non-TTTS-with-symptoms) have discordant fetal growth patterns that correlate with our previously derived algebraic relations. Methods: In 25 monochorionic twin pregnancies, fetal growth was determined by standard ultrasonography. The difference between estimated fetal weights (dEFW) as well as the difference divided by the average of the two weights, the difference average ratio (DAR), were fitted to the predicted trends of discordant fetal growth for TTTS and non-TTTS pregnancies. The best fits were compared with the clinical data. Results: Out of 13 TTTS cases, dEFW analysis correctly correlated with 8 (62%) and DAR analysis correctly with 10 (77%). Out of 12 non-TTTS-with-symptoms cases, dEFW analysis correctly correlated with 7 (58%) and DAR analysis correctly with 9 (75%). If TTTS correlated best, dEFW analysis was correct in 8/12 (67%), and DAR analysis in 10/11 (91%) cases. If non-TTTS correlated best, dEFW analysis was correct in 7/9 (78%), and DAR analysis in 9/12 (75%). The likelihood ratios of TTTS and non-TTTS were 1.9 and 0.26, respectively, with dEFW analysis, and 9.2 and 0.31 with DAR analysis. Conclusion: The simple algebraic relations derived to identify trends of fetal discordant growth show evidence that clinical TTTS and non-TTTS manifestations are quantifiable. The relations may contribute to future risk stratification in monochorionic twin pregnancies, e.g., by prospectively distinguishing between cases that will develop TTTS and those that will not, despite presenting with symptoms.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Discordant Fetal Growth Patterns in Monochorionic Twin Pregnancies Described by Simple Algebraic Relations

Umur

Gemert²,

Schaap³

et al. 2003

Fetal Diagn Ther

Self Cite

View full text Add to dashboard Cite

show abstract

“…Caused by uncompensated fetofetal transfusion through a placental arteriovenous (AV) connection from one twin (the donor) to the other (the recipient), TTTS often leads to intrauterine fetal death or premature delivery (24,49). TTTS severity can be mitigated by other, compensating anastomoses, which return part of the AV transfusion back to the donor twin [i.e., opposite arteriovenous (VA), arterioarterial (AA) (45), and venovenous (VV) anastomoses].…”

mentioning

confidence: 99%

A mathematical model of twin-twin transfusion syndrome with pulsatile arterial circulations

Wijngaard¹,

Westerhof²,

Ross³

et al. 2007

American Journal of Physiology-Regulatory, Integrative and Comp

Self Cite

View full text Add to dashboard Cite

December 7, 2006; doi:10.1152/ajpregu.00534.2006.-The twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies caused by a net transfusion of blood from one twin (the donor) to the other (the recipient) through placental anastomoses. To examine the pathophysiology of TTTS evolving through clinical stages I to IV, we extended our mathematical model to include pulsating circulations propagating along the arterial tree as well as placental and cerebral vascular resistances, and arterial wall thickness and stiffness. The model demonstrates that abnormal umbilical arterial flow (TTTS stage III) in the donor twin results from increased placental resistance as well as reduced resistance in the cerebral arteries. In contrast, recipient twin abnormal umbilical arterial flow requires a significantly greater increase in placental resistance, resulting from the compressive effects of high amniotic fluid pressure. Thus simulated abnormalities of donor umbilical arterial pulsations occur in the donor more commonly and earlier than in the recipient. The "normal" staging sequence (I, II, III, IV) correlates with the presence of compensating placental anastomoses, constituting the majority of monochorionic twin placentas. However, TTTS stage III may occur before manifestations of stage II (lack of donor bladder filling), in our model correlating with severe TTTS from a single arteriovenous anastomosis, an infrequent occurring placental angioarchitecture. In conclusion, this mathematical model describes the onset and development of the four stages of TTTS, reproduces a variety of clinical manifestations, and may contribute to identifying the underlying pathophysiology of the staging sequence in TTTS. stage III; quintero staging sequence IN THE UNITED STATES, about 10% of all monochorionic twin pregnancies, resulting in ϳ3,000 fetal twin pairs each year, develop twin-twin transfusion syndrome (TTTS). Caused by uncompensated fetofetal transfusion through a placental arteriovenous (AV) connection from one twin (the donor) to the other (the recipient), TTTS often leads to intrauterine fetal death or premature delivery (24, 49). TTTS severity can be mitigated by other, compensating anastomoses, which return part of the AV transfusion back to the donor twin [i.e., opposite arteriovenous (VA), arterioarterial (AA) (45), and venovenous (VV) anastomoses].TTTS is believed to progress through four worsening stages of severity with both twins alive (36). Stage I TTTS is diagnosed by the oligo-polyhydramnios sequence, where the donor has almost no amniotic fluid and the recipient simultaneously has excess amniotic fluid. More severe stages of TTTS often develop subsequently: stage II includes lack of donor bladder filling; stage III, abnormal umbilical flows in either twin (i.e., reduced or reversed end-diastolic flow) (21); and stage IV, congestive cardiac failure and hydrops in the recipient.The syndrome has a largely inaccessible pathophysiology, because invasive fetal study is unethical and an ani...

show abstract

Hypothesis acardiac twin pregnancies: Pathophysiology‐based hypotheses suggest risk prediction by pump/acardiac umbilical venous diameter ratios

Gemert

Pistorius

Benirschke

et al. 2015

Birth Defects Research

Self Cite

View full text Add to dashboard Cite

show abstract

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

Cited by 103 publications

References 60 publications

Discordant Fetal Growth Patterns in Monochorionic Twin Pregnancies Described by Simple Algebraic Relations

Discordant Fetal Growth Patterns in Monochorionic Twin Pregnancies Described by Simple Algebraic Relations

A mathematical model of twin-twin transfusion syndrome with pulsatile arterial circulations

Hypothesis acardiac twin pregnancies: Pathophysiology‐based hypotheses suggest risk prediction by pump/acardiac umbilical venous diameter ratios

Contact Info

Product

Resources

About