The twin–twin transfusion syndrome

Wee, Ling Y, and Fisk, Nicholas M. (2002) The twin–twin transfusion syndrome. Seminars in Neonatology, 7 3: 187-202. doi:10.1053/siny.2002.0106

Author Wee, Ling Y,
Fisk, Nicholas M.
Title The twin–twin transfusion syndrome
Journal name Seminars in Neonatology   Check publisher's open access policy
ISSN 1084-2756
Publication date 2002-06-01
Sub-type Article (original research)
DOI 10.1053/siny.2002.0106
Open Access Status
Volume 7
Issue 3
Start page 187
End page 202
Total pages 16
Place of publication London, U.K.
Publisher W B Saunders
Language eng
Subject 111401 Foetal Development and Medicine
111402 Obstetrics and Gynaecology
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
Formatted abstract
The aetiology of twin–twin transfusion syndrome (TTTS), which affects 10–15% of monochorionic (MC) twin pregnancies, remains poorly understood. Although all MC twins have placental vascular anastomoses, unbalanced intertwin transfusion has been shown by ex vivo injection and in vivo Doppler studies of chorionic plate vasculature to be mediated by ≥1 arterio-venous anastomoses (AVA) in association with absent bi-directional arterio-arterial anastomoses (AAA). TTTS presents in the mid trimester with the oligo-polyhydramnios sequence, the donor may have a small or non-visible bladder and abnormal umbilical artery Doppler, while the recipient has a large bladder and may develop cardiac hypertrophy, triscupid regurgitation, and eventually hydrops. Recently, discordant renal renin angiotensin expression, endothelin and atrial natriuretic peptide have been implicated in the pathogenesis. Survival has increased from <20% to <60–70% with modern treatments, although survivors remain at increased risk of antenatally acquired cerebral white matter injury, and neurodevelopmental sequelae are documented in c. 10% (range 5–23%). The recent introduction of a staging system for TTTS facilitates selection of therapy with less invasive amnioreduction and septostomy preferred for early stage disease, and more aggressive modalities such as laser ablation and cord occlusion with their attendant risk of procedure related fetal loss, reserved for advanced stage disease.
Copyright © 2002 Elsevier Science Ltd. All rights reserved.

Keyword Monochorionic twins
Twin–twin transfusion syndrome
Cerebral palsy
Laser ablation
Placental vascular anastomoses
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Citation counts: Scopus Citation Count Cited 59 times in Scopus Article | Citations
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Created: Thu, 19 Mar 2009, 23:17:16 EST by Maryanne Watson on behalf of Faculty Of Health Sciences