The basic and clinical science of twin-twin transfusion syndrome

Fisk, N., Duncombe, G.J. and Sullivan M.H.F. (2009) The basic and clinical science of twin-twin transfusion syndrome. Placenta, 30 5: 379-390. doi:10.1016/j.placenta.2009.02.005


Author Fisk, N.
Duncombe, G.J.
Sullivan M.H.F.
Title The basic and clinical science of twin-twin transfusion syndrome
Formatted title

Journal name Placenta   Check publisher's open access policy
ISSN 0143-4004
Publication date 2009-03-10
Year available 2009
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.placenta.2009.02.005
Volume 30
Issue 5
Start page 379
End page 390
Total pages 12
Place of publication London, U.K.
Publisher Elsevier, Ltd.
Collection year 2010
Language eng
Subject 1103 Clinical Sciences
970111 Expanding Knowledge in the Medical and Health Sciences
C1
111401 Foetal Development and Medicine
Abstract Twin–twin transfusion syndrome (TTTS) is a fascinating condition in which fetuses of identical genotype adopt discordant cardiovascular phenotypes, secondary to unbalanced placental inter-twin transfusion. Flow along the primary units of inter-twin transfusion, unidirectional arteriovenous anastomoses, can be as high as litres/day each, and TTTS develops when the placenta has insufficient compensatory counter-transfusional anastomoses. The initial phenotype reflects dysvolaemia, with added contributions from uteroplacental insufficiency in the donor, and raised afterload with diastolic dysfunction secondary to discordant endothelin and placentally derived renin–angiotensin system effectors in the recipient. Endoscopic laser ablation of placental anastomoses has become the primary treatment modality, supported by a randomised trial showing improved survival and short but not long-term neurological morbidity. Its uptake has facilitated comparative pre- and post-laser studies, which provide considerable insight into the pathophysiology. Despite the therapeutic advance, placental laser remains associated with a 25% incidence of fetal death within a week, and a 10% risk each of recurrence and twin anaemia/polycythaemia sequence due to residual anastomoses. In Stage I, high rates of non-progression with more conservative management have resulted in therapeutic equipoise as to whether laser is indicated primarily or only for progressive disease. The challenge ahead lies in improving double intact survival rates, which in addition to randomised trials will require technical advances, better understanding of the circulatory pathophysiology and more sophisticated surveillance tools.
Keyword Feto-fetal transfusion
Monochorionic placentation
Discordant twins
Laser Therapy
Renin-angiotensin
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: UQ Centre for Clinical Research Publications
2010 Higher Education Research Data Collection
 
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Created: Wed, 19 Aug 2009, 20:33:31 EST by Carmen Buttery on behalf of UQ Centre for Clinical Research