Twin-twin transfusion syndrome | Acog TTTS

Home»Publications&Guidelines»Twin-twintransfusionsyndromeTwin-twintransfusionsyndromeDiagnosis/definition:ThediagnosisofTTTSrequires2criteria:(1)thepresenceofamonochorionicdiamniotic(MCDA)pregnancy;and(2)thepresenceofoligohydramnios(definedasamaximalverticalpocket<2cm)inonesacandpolyhydramnios(definedasamaximalverticalpocket>8cm)intheothersac.TheQuinterostagingsystem(Table1)appearstobeausefultoolfordescribingtheseverityofTTTSinastandardizedfashion.Epidemiology/Incidence:TTTScomplicatesabout8-10%ofMCDApregnancies.TheprevalenceofTTTSisapproximately1-3per10,000births.Pathophysiology:TheprimaryetiologyofTTTSisthoughttoinvolveintertwinvascularconnectionswithintheplacenta(Figure4).Animbalanceofbloodflowthroughplacentalanastemosesleadstovolumedepletioninthedonortwin,witholiguriaandoligohydramnios,andtovolumeoverloadintherecipienttwin,withpolyuriaandpolyhydramnios.Complexinteractionsoftherenin-angiotensinsysteminthetwinsalsoappeartobeinvolvedinthedevelopmentofthisdisorder.Riskfactors/associations:Thereareseveralsecond-andevenfirst-trimestersonographicfindingsthathavebeenassociatedwithTTTS(Table3).Complications:ThepresentationofTTTSishighlyvariableandoftendoesnotprogressinapredictablemanner.SingletwinsurvivalratesinTTTSvarywidelybetween15-70%,dependingongestationalageatdiagnosisandseverityofdisease.Twothirdsofrecipienttwinsshowdiastolicdysfunction,asindicatedbyaprolongedventricularisovolumetricrelaxationtime,whichisassociatedwithanincreasedriskoffetaldeath.Scoringsystemsthatincludecardiacdysfunctionhavebeendeveloped,buttheirusefulnesstopredictoutcomeinTTTSremainscontroversial.Thenaturalhistoryofadvanced(eg,stage>III)TTTSisbleak,withareportedperinatallossrateof70-100%,particularlywhenitpresents<26weeks.Evenlaser-treatedTTTSisassociatedwithaperinatalmortalityrateof30-50%(Table7),anda5-20%chanceoflong-termneurologichandicap(Table8).Althoughtheriskofmembranerupturemaybeaslowas10%inexperiencedcenters,thereremainsa10-30%procedure-associatedfetallosswithlaser.Management:(Figure10)S

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Twin-Twin Transfusion Syndrome Confers Persistent Morbidity... | Acog TTTS
INTRODUCTION: Selective fetoscopic laser photocoagulation (SFLP) for pregnancies complicated by twin-twin transfusion syndrome (TTTS) has improved outcomes ...
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Twin-twin transfusion syndrome | Acog TTTS
TTTS is a serious condition that can complicate 8-10% of twin pregnancies with monochorionic diamniotic (MCDA) placentation.
Multiple Pregnancy | Acog TTTS
In TTTS, the blood flow between the twins becomes unbalanced. One twin donates blood to the other twin. The donor twin has too little blood, and the recipient ...
Twin-twin transfusion syndrome | Acog TTTS
Diagnosis/definition: The diagnosis of TTTS requires 2 criteria: (1) the presence of a monochorionic diamniotic (MCDA) pregnancy; and (2) the presence of ...