Twin-twin transfusion syndrome
1Society for Maternal-Fetal Medicine Publications Committee, Washington, DC, USA.
American Journal of Obstetrics and Gynecology
|December 4, 2012
Summary
Twin-twin transfusion syndrome (TTTS) is a serious complication in monochorionic diamniotic pregnancies. Early diagnosis and appropriate management, including expectant care for early stages and laser therapy for advanced stages, are crucial for improving perinatal survival.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Fetal Surgery
Background:
- Twin-twin transfusion syndrome (TTTS) complicates 8-10% of monochorionic diamniotic (MCDA) twin pregnancies.
- Diagnosis requires MCDA placentation with specific criteria for oligohydramnios and polyhydramnios.
Purpose of the Study:
- To review the natural history, pathophysiology, diagnosis, and treatment of TTTS.
- To provide evidence-based recommendations for managing TTTS.
Main Methods:
- Systematic review of MEDLINE, PubMed, EMBASE, and Cochrane Library (1966-2012).
- Inclusion of original research, RCTs, review articles, and guidelines.
- Quality evaluation based on the highest level of evidence.
Main Results:
- The Quintero staging system standardizes TTTS severity assessment.
- Serial sonographic evaluation is recommended for MCDA twins starting at 16 weeks.
- Congenital heart disease screening is warranted for all monochorionic twins.
Conclusions:
- Stage I TTTS often shows spontaneous regression or stability with high survival rates (86%) under expectant management.
- Advanced TTTS (stage ≥III) has a bleak prognosis (70-100% perinatal loss), especially before 26 weeks.
- Fetoscopic laser photocoagulation is recommended for advanced TTTS before 26 weeks, despite no significant survival benefit in meta-analyses and potential for neurologic handicap.
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