Twin to twin transfusion syndrome

Area of Science:

• Maternal-Fetal Medicine
• Perinatology
• Fetal Surgery

Background:

• Twin to twin transfusion syndrome (TTTS) is a serious complication in 10-15% of monochorionic pregnancies.
• It results from abnormal placental vascular connections leading to unequal blood flow between twins.
• Untreated TTTS causes significant fetal loss, especially in advanced stages.

Purpose of the Study:

• To review the diagnosis, treatment, and outcomes of twin to twin transfusion syndrome (TTTS).
• To highlight the role of ultrasound and fetal cardiac function in assessment.
• To discuss the effectiveness of fetoscopic laser ablation and long-term sequelae.

Main Methods:

• Ultrasound for diagnosing monochorionicity and TTTS, assessing amniotic fluid, and Doppler patterns.
• Fetal cardiac function assessment.
• Fetoscopic laser ablation of placental vascular anastomoses.

Main Results:

• Fetoscopic laser ablation is the standard treatment for TTTS.
• Post-treatment survival rates are up to 65% for both twins and 88% for a single twin.
• Preterm birth and potential long-term neurological impairment (up to 11%) are significant concerns.

Conclusions:

• Fetoscopic laser ablation improves survival in TTTS.
• Minimizing preterm birth and standardizing reporting are crucial for better outcomes.
• Long-term neurodevelopmental follow-up is essential for TTTS survivors.