Twin to twin transfusion syndrome
1Department of Paediatrics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. docrameshbhat@yahoo.co.in
Kathmandu University Medical Journal (KUMJ)
|January 7, 2011
Summary
Twin to twin transfusion syndrome (TTTS) involves unbalanced blood flow in monochorionic pregnancies, leading to severe complications. Early ultrasound detection and amnioreduction are key management strategies for this high-risk condition.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Fetal Medicine
Background:
- Twin to twin transfusion syndrome (TTTS) affects 10-15% of monochorionic pregnancies.
- It arises from unbalanced blood flow through intertwin vascular anastomoses.
- Superficial anastomoses may fail to compensate for deeper unidirectional shunts.
Observation:
- TTTS is associated with significant perinatal mortality.
- Donor twins often present with hypovolemia, anemia, and heart failure.
- Recipient twins typically exhibit polycythemia and increased weight.
Findings:
- Antenatal diagnosis is usually made via second-trimester ultrasound.
- Serial amnioreduction is the standard therapeutic approach.
- Postnatal diagnosis relies on hemoglobin and birth weight discrepancies.
Implications:
- Management focuses on addressing anemia, polycythemia, and hydrops postnatally.
- Understanding anastomotic patterns is crucial for predicting TTTS development.
- Effective management strategies are vital for improving outcomes in affected twins.
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