Am J Perinatol 2014; 31(07): 583-594
DOI: 10.1055/s-0034-1372428
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Twin-to-Twin Transfusion Syndrome: Prenatal Diagnosis and Treatment

Richard M. Benoit
1  Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
,
Ahmet A. Baschat
1  Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

16 December 2013

10 February 2014

Publication Date:
23 May 2014 (eFirst)

Abstract

Clinical Problem Twin-to-twin transfusion syndrome (TTTS) increases perinatal morbidity and mortality for 10 to 15% of monochorionic (MC) gestations.

Pathophysiology MC gestations are at risk due to the angioarchitecture of the shared placenta, with anastomoses of varying type, size, and quantity. TTTS results from progression of a chronic perfusion imbalance across unbalanced placental anastomoses, typically arising between 15 and 26 weeks gestation. The resulting abnormal fetal blood volume levels and compensatory physiological responses lead to an increased risk for fetal death, end-organ damage, and preterm birth.

Prenatal Diagnosis Surveillance with ultrasound is essential for detection and treatment. TTTS is diagnosed once polyhydramnios occurs in the recipient (maximal vertical fluid pocket [MVP] > 8 cm) and oligohydramnios in the donor (MVP < 2 cm). The Quintero et al method is commonly used for staging, utilizing the presence or absence of donor bladder filling, abnormal fetal Doppler values, fetal hydrops, and demise.

Treatment Fetoscopic laser photocoagulation of placental anastomoses is an effective treatment addressing the underlying pathophysiology. Further research is needed to improve survival rates, reduce risks of fetoscopy, and gain understanding of the prediction, assessment, and optimization of long-term outcomes for TTTS survivors.