Twin–twin transfusion syndrome – What we have learned from clinical trials

Djaafri, Fatiha; Stirnemann, J.; Mediouni, Imen; Colmant, C.; Ville, Y.

doi:10.1016/j.siny.2017.08.005

Cited by 32 publications

(28 citation statements)

References 76 publications

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“…This leads to the quick development of a significant discordance in amniotic fluid volume between the twins, described as twin polyhydramnios-oligohydramnios sequence (TOPS). Hormonal dysregulation has been implicated to play a role in the further development of the syndrome [10,11]. TOPS can be detected with prenatal ultrasound and is the hallmark of TTTS diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Spruijt

Lopriore

Steggerda

et al. 2020

Expert Review of Hematology

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Introduction: Twin-twin transfusion syndrome (TTTS) is a devastating complication of monochorionic twin pregnancy and remains a major challenge for worldwide fetal medicine specialists. In TTTS, intertwin transfusion through vascular anastomoses in the shared placenta leads to severe hemodynamic imbalance. This review summarizes the current knowledge of TTTS. Areas covered: The most recent insights concerning the management of TTTS, as well as fetal and neonatal complications are described. Relevant articles were selected based on a Pubmed search using the keywords below. Understanding of the underlying pathophysiology has improved greatly as a result of placental injection studies. Advancements in antenatal management have led to increased perinatal survival and a decreased incidence of neonatal complications, including brain injury and neurodevelopmental impairment. Expert opinion: Further opportunities for improvement comprise technological innovations in laser procedures and the prevention of preterm rupture of membranes with subsequent prematurity. A noninvasive treatment such as high-intensity focused ultrasound (HIFU) seems to hold promise for the future treatment of TTTS. Fetal MRI studies are important to improve our understanding of fetal brain injury and should relate their findings to long-term neurodevelopment. International collaboration and centralization of care are of paramount importance to ensure the best care for our patients.

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Section: Introductionmentioning

confidence: 99%

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Spruijt

Lopriore

Steggerda

et al. 2020

Expert Review of Hematology

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“…Both twins are exposed to high levels of RAS components and placental anastomoses could play a role of in the transfer of RAAS components from donor to recipient [27]. The blood flow shift to the recipient fetus and prolonged exposure of the donor twin to vasoconstrictive influence aggravate renal hypoperfusion, resulting in persistent activation of RAAS thus maintaining the vicious circle [28].…”

Section: Ttts Pathophysiologymentioning

confidence: 99%

“…The classification used for TTTS stadialization described by Quintero is depicted in table I. The results of multicentric randomized trials proved the superiority of LASER treatment over serial amnioreductions in terms of survival and neurologic morbidity for Quintero stage ≥2 TTTS [28]. The occlusion of the vascular connections between the twins stops the abnormal blood circulation, improving the cardiovascular function in the recipient with normalization of systolic and diastolic function [30,47].…”

Section: Antenatal Therapy and Its Implication On The Cardiovascular mentioning

confidence: 99%

Fetal cardiovascular alterations in twin-to-twin transfusion syndrome

Rotar

Zaharie

Staicu

et al. 2020

Medicine and Pharmacy Reports

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Twin-to-twin transfusion syndrome (TTTS) is the consequence of vascular anastomoses of the shared placenta of monochorionic twin pregnancies. Both circulating inter-twin blood flow and vasoactive mediators imbalance cause hypovolemia in the donor and hypervolemia in the recipient fetus. If left untreated, TTTS has a high perinatal mortality rate and adverse long-term outcomes mainly cardiovascular and neurological. The recipient has cardiovascular changes including atrioventricular valve regurgitation, diastolic dysfunction and pulmonary stenosis/atresia. The maladaptive response to vascular changes determines a constant decreased blood flow in the donor that permanently modifies the arterial structure leading to postnatal alterations in the vascular system. Fetoscopic LASER surgery of placental vascular anastomoses may disrupt the underlying pathophysiology and improves cardiovascular function with normalization of systolic and diastolic function within weeks after treatment. The impact of cardiovascular changes is relevant for the safety of the management of a TTTS case. The improvement of the perinatal survival after intrauterine surgery leads to viable infants with the longer-term sequelae. Therefore accurate quantification of cardiovascular involvement is essential for clinicians for pregnancy management but also for patient counseling about the potential treatment options the outcome.

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“…Ultrasonography is central to the proper diagnosis of the type of twinning. Monochorionic twin pregnancies are at increased risk for adverse outcomes compared to dichorionic twin pregnancies and singletons, including twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, single intrauterine fetal demise and its consequences on the co-twin, and selective intrauterine growth restriction [ 78 ]. In particular, TTTS is associated with significant mortality and morbidity [ 79 ].…”

Section: Ductus Venosusmentioning

confidence: 99%

Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart

Braga

Moleiro

Guedes-Martins

2019

CCR

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The ductus venosus is a vascular shunt situated within the fetal liver parenchyma, connecting the umbilical vein to the inferior vena cava. This vessel acts as a bypass of the liver microcirculation and plays a critical role in the fetal circulation. The ductus venosus allows oxygenated and nutrient-rich venous blood to flow from the placenta to the myocardium and brain. Increased impedance to flow in the fetal ductus venosus is associated with fetal aneuploidies, cardiac defects and other adverse pregnancy outcomes. This review serves to improve our understanding of the mechanisms that regulate the blood flow redistribution between the fetal liver circulation and fetal heart and the clinical significance of the ductus venosus waveform as generated by pressure-volume changes in the fetal heart.

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Twin–twin transfusion syndrome – What we have learned from clinical trials

Cited by 32 publications

References 76 publications

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Fetal cardiovascular alterations in twin-to-twin transfusion syndrome

Clinical Significance of Ductus Venosus Waveform as Generated by Pressure- volume Changes in the Fetal Heart

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