Twin-twin transfusion syndrome.
Claudia Mosquera1, Russell S Miller, Lynn L Simpson
1Carmen and John Thain Center for Prenatal Pediatrics, Columbia University Medical Center, New York, NY 10032, USA. cm2973@columbia.edu
Seminars in Perinatology
|June 21, 2012
Summary
Twin-twin transfusion syndrome (TTTS) is a serious pregnancy complication affecting monochorionic twins. Early monitoring and intervention, like fetoscopic laser photocoagulation, are crucial for improving outcomes.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Twin Gestation Research
Background:
- Twin-twin transfusion syndrome (TTTS) affects 10-15% of monochorionic diamniotic twin pregnancies.
- Pathophysiology involves unbalanced placental vascular communications in a shared circulation.
- Variable presentation necessitates vigilant monitoring.
Purpose of the Study:
- To highlight the importance of serial sonographic monitoring for TTTS detection.
- To discuss management options for early and advanced TTTS.
- To evaluate the efficacy and risks of fetoscopic laser photocoagulation.
Main Methods:
- Serial second-trimester sonographic monitoring of monochorionic twin gestations.
- Conservative management for early TTTS.
- Fetoscopic laser photocoagulation for advanced TTTS.
Main Results:
- Early TTTS can be managed conservatively.
- Advanced TTTS without intervention has high perinatal loss and neurologic impairment risks.
- Fetoscopic laser photocoagulation is the preferred treatment for advanced TTTS, despite residual risks.
Conclusions:
- Early detection and management of TTTS are critical for improving twin pregnancy outcomes.
- Fetoscopic laser photocoagulation offers the best available treatment for advanced TTTS.
- Ongoing risks of twin demise and neurologic handicap persist even after laser therapy.
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