The twin-twin transfusion syndrome

Jain, Venu and Fisk, Nicholas M. (2004) The twin-twin transfusion syndrome. Clinical Obstetrics & Gynecology, 47 1: 181-202. doi:10.1097/00003081-200403000-00020

Author Jain, Venu
Fisk, Nicholas M.
Title The twin-twin transfusion syndrome
Journal name Clinical Obstetrics & Gynecology   Check publisher's open access policy
ISSN 0009-9201
Publication date 2004-03-01
Year available 2004
Sub-type Article (original research)
DOI 10.1097/00003081-200403000-00020
Open Access Status
Volume 47
Issue 1
Start page 181
End page 202
Total pages 22
Place of publication New York, U.S.A.
Publisher Harper & Row
Language eng
Subject 111402 Obstetrics and Gynaecology
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Twin–twin transfusion syndrome (TTTS) is a complex cardiovascular disease affecting monochorionic (MC) twin pregnancies. Although well characterized clinically, its etiopathogenesis remains poorly understood. TTTS, which affects genetically-identical structurally normal fetuses, primarily involves unbalanced transfusion of blood from a net donor to a net recipient along one or more placental arteriovenous anastomoses in absence of adequate compensatory counter-transfusion along bidirectional superficial anastomoses. The resultant fetal hemodynamic changes, and their associated biochemical/humoral adaptations are responsible for the disparate phenotypic features found in the donor and recipient twins. TTTS is arguably the oldest medical condition recorded. As described in the Bible (Genesis 25:21–32), it appears that the twins of Isaac and Rebekah who “struggled together within her” were afflicted with TTTS. The first born, Esau, who “came out red,” was “faint,” and “at the point to die,” may have been a recipient. Today, TTTS remains one of the greatest challenges in modern fetal medicine for several reasons. Firstly, untreated, it is associated with extremely high perinatal mortality (>= 80%) and morbidity. Secondly, not one but two babies are affected. Third, unlike many other fetal pathologies, these babies are entirely normal structurally, thus with good potential for intact survival. Finally, the problem is an anatomic one in the placenta, which should, at least theoretically, be amenable to surgical cure. Because disease severity varies from subclinical to life threatening, and because of the multitude of treatment options available, clinical management of TTTS remains challenging, despite considerable recent advances.
Copyright: © 2004 Lippincott Williams & Wilkins, Inc.

Keyword Twin–twin transfusion syndrome (TTTS)
Unbalanced transfusion
Placental arteriovenous anastomoses
Q-Index Code C1
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: TR Web of Science Citation Count  Cited 44 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 23 Mar 2009, 21:38:40 EST by Maria Campbell on behalf of Faculty Of Health Sciences