Am J Perinatol 2014; 31(S 01): S7-S12
DOI: 10.1055/s-0034-1376184
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Twin-to-Twin Transfusion Syndrome—30 Years at the Front

Julian E. De Lia
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Randall S. Kuhlmann
1   Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations
Further Information

Publication History

03 March 2014

02 April 2014

Publication Date:
10 June 2014 (online)

Abstract

Thirty years ago, twin-to-twin transfusion syndrome (TTTS) was one of the most challenging problems of modern obstetrics. The associated mortality and morbidity was staggering, and a sense of hopelessness prevailed among clinicians and pediatric pathologists. Technical advances in ultrasound, endoscopy, video recording, and medical lasers formed the basis for diagnosis and in utero therapy of placental disorders. We review some historical events which gave rise to a new treatment modality for TTTS, fetoscopic laser occlusion of chorioangiopagous vessels, now the most common operation performed worldwide in behalf of fetuses in peril.

 
  • References

  • 1 Wittmann BK, Baldwin VJ, Nichol B. Antenatal diagnosis of twin transfusion syndrome by ultrasound. Obstet Gynecol 1981; 58 (1) 123-127
  • 2 Schatz F. Eine besondere Art von einseitiger Polyhydramnie mit anderseitiger Oligohydramnie bei eineiigen Zwillingen. Arch Gynakol 1882; 19: 329-369
  • 3 Chescheir NC, Seeds JW. Polyhydramnios and oligohydramnios in twin gestations. Obstet Gynecol 1988; 71 (6, Pt 1) 882-884
  • 4 Moore TR, Garrett V, Benirschke K. Prognostic factors for survival in the twin transfusion syndrome. SPO Abstract #152. Am J Obstet Gynecol 1991; 164: 289
  • 5 Patten RM, Mack LA, Harvey D, Cyr DR, Pretorius DH. Disparity of amniotic fluid volume and fetal size: problem of the stuck twin—US studies. Radiology 1989; 172 (1) 153-157
  • 6 Lingman G, Ohrlander S, Ohlin P. Intrauterine digoxin treatment of fetal paroxysmal tachycardia: case report. Br J Obstet Gynaecol 1980; 87 (4) 340-342
  • 7 Harrigan JT, Kangos JJ, Sikka A , et al. Successful treatment of fetal congestive heart failure secondary to tachycardia. N Engl J Med 1981; 304 (25) 1527-1529
  • 8 De Lia J, Emery MG, Sheafor SA, Jennison TA. Twin transfusion syndrome: successful in utero treatment with digoxin. Int J Gynaecol Obstet 1985; 23 (3) 197-201
  • 9 Valdes Jr R, Graves SW, Brown BA, Landt M. Endogenous substance in newborn infants causing false positive digoxin measurements. J Pediatr 1983; 102 (6) 947-950
  • 10 Pudek MR, Seccombe DW, Jacobson BE, Whitfield MF. Seven different digoxin immunoassay kits compared with respect to interference by a digoxin-like immunoreactive substance in serum from premature and full-term infants. Clin Chem 1983; 29 (11) 1972-1974
  • 11 Dasgupta A. Endogenous and exogenous digoxin-like immunoreactive substances: impact on therapeutic drug monitoring of digoxin. Am J Clin Pathol 2002; 118 (1) 132-140
  • 12 Jelliffe RW, Brooker G. A nomogram for digoxin therapy. Am J Med 1974; 57 (1) 63-68
  • 13 Naeye RL. Human intrauterine parabiotic syndrome and its complications. N Engl J Med 1963; 268: 804-809
  • 14 Naeye RL. The fetal and neonatal development of twins. Pediatrics 1964; 33: 546-553
  • 15 Benirschke K, Driscoll SG . The Pathology of the Human Placenta. New York: Springer-Verlag; 1967
  • 16 Strong SJ, Corney G . The Placenta in Twin Pregnancy. Oxford: Pergamon Press; 1967
  • 17 Robertson EG, Neer KJ. Placental injection studies in twin gestation. Am J Obstet Gynecol 1983; 147 (2) 170-174
  • 18 Baldwin V . Pathology of Multiple Pregnancy. New York: Springer-Verlag; 1994
  • 19 Machin GA. Some causes of genotypic and phenotypic discordance in monozygotic twin pairs. Am J Med Genet 1996; 61 (3) 216-228
  • 20 Mandelbaum B, Pontarelli DA, Brushenko A. Amnioscopy for prenatal transfusion. Am J Obstet Gynecol 1967; 98 (8) 1140-1143
  • 21 Phillips JM. Fetoscopy: its genesis and promise. J Reprod Med 1978; 21 (3) 115-122
  • 22 Rodeck CH, Nicolaides KH. Fetal tissue biopsy: techniques and indications. Fetal Ther 1986; 1 (1) 46-58
  • 23 De Lia JE . The Nd:YAG laser in fetal/placenta surgery. In: Keye WR, ed. Laser Surgery in Gynecology and Obstetrics. Chicago, IL: Year Book Medical Publishers; 1990. :242–249
  • 24 De Lia JE, Rogers JG, Dixon JA. Theoretical treatment of placental vascular anomalies with neodymium:YAG laser via fetoscopy. Am J Obstet Gynecol 1985; 151: 1126-1127
  • 25 DeLia JE, Cukierski MA, Lundergan DK, Kochenour NK. Neodymium: yttrium-aluminum-garnet laser occlusion of rhesus placental vasculature via fetoscopy. Am J Obstet Gynecol 1989; 160 (2) 485-489
  • 26 De Lia JE, Cruikshank DP, Keye Jr WR. Fetoscopic neodymium: YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome. Obstet Gynecol 1990; 75 (6) 1046-1053
  • 27 De Lia JE, Kuhlmann RS, Cruikshank DP, O'Bee LR. Current topic: placental surgery: a new frontier. Placenta 1993; 14 (5) 477-485
  • 28 Elliott JP. Amniocentesis for twin-twin transfusion syndrome. Contemp Ob Gyn 1992; 37: 30-47
  • 29 Monie IW. Velamentous insertion of the cord in early pregnancy. Am J Obstet Gynecol 1965; 93: 276-281
  • 30 Gaziano EP, De Lia JE, Kuhlmann RS. Diamnionic monochorionic twin gestations: an overview. J Matern Fetal Med 2000; 9 (2) 89-96
  • 31 Ville Y, Hyett J, Hecher K, Nicolaides K. Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med 1995; 332 (4) 224-227
  • 32 De Lia JE, Kuhlmann RS, Harstad TW, Cruikshank DP. Fetoscopic laser ablation of placental vessels in severe previable twin-twin transfusion syndrome. Am J Obstet Gynecol 1995; 172 (4, Pt 1) 1202-1208 , discussion 1208–1211
  • 33 De Lia JE. Surgery of the placenta and umbilical cord. Clin Obstet Gynecol 1996; 39 (3) 607-625
  • 34 Grafe MR. Antenatal cerebral necrosis in monochorionic twins. Pediatr Pathol 1993; 13 (1) 15-19
  • 35 Ulfig N, Nickel J, Saretzki U. Alterations in myelin formation in fetal brains of twins. Pediatr Neurol 1998; 19 (4) 287-293
  • 36 Glinianaia SV, Pharoah PO, Wright C, Rankin JM ; Northern Region Perinatal Mortality Survey Steering Group. Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor. Arch Dis Child Fetal Neonatal Ed 2002; 86 (1) F9 –F15
  • 37 Blickstein I. Cerebral palsy in multifoetal pregnancies. Dev Med Child Neurol 2002; 44 (5) 352-355
  • 38 Skibsted L, Lundvall L, Brocks V, Bang J. Selective foeticidium using YAG laser [in Danish]. Ugeskr Laeger 1999; 161 (41) 5687-5688
  • 39 Rossi AC, D'Addario V. Comparison of donor and recipient outcomes following laser therapy performed for twin-twin transfusion syndrome: a meta-analysis and review of literature. Am J Perinatol 2009; 26 (1) 27-32
  • 40 Carroll SG, McLennan A, Maxwell DJ. Fetal hemoglobin changes in the twin oligohydramnios-polyhydramnios sequence. Ultrasound Obstet Gynecol 1997; 9 (6) 398-402
  • 41 Luks FI, Carr SR, Plevyak M , et al. Limited prognostic value of a staging system for twin-to-twin transfusion syndrome. Fetal Diagn Ther 2004; 19 (3) 301-304
  • 42 Bruner JP, Rosemond RL. Twin-to-twin transfusion syndrome: a subset of the twin oligohydramnios-polyhydramnios sequence. Am J Obstet Gynecol 1993; 169 (4) 925-930
  • 43 Weiner CP, Ludomirski A. Diagnosis, pathophysiology, and treatment of chronic twin-to-twin transfusion syndrome. Fetal Diagn Ther 1994; 9 (5) 283-290
  • 44 Bendon RW. Twin transfusion: pathological studies of the monochorionic placenta in liveborn twins and of the perinatal autopsy in monochorionic twin pairs. Pediatr Pathol Lab Med 1995; 15 (3) 363-376
  • 45 De Lia JE, Kuhlmann RS, Emery MG. Maternal metabolic abnormalities in twin-to-twin transfusion syndrome at mid-pregnancy. Twin Res 2000; 3 (2) 113-117
  • 46 Meagher S, Tippett C, Renou P, Baker L, Susil B. Twin-twin transfusion syndrome: intraamniotic pressure measurement in the assessment of volume reduction at serial amniocenteses. Aust N Z J Obstet Gynaecol 1995; 35 (1) 22-26
  • 47 Garry D, Lysikiewicz A, Mays J, Canterino J, Tejani N. Intra-amniotic pressure reduction in twin-twin transfusion syndrome. J Perinatol 1998; 18 (4) 284-286
  • 48 Newman RB, Iams JD, Das A , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. A prospective masked observational study of uterine contraction frequency in twins. Am J Obstet Gynecol 2006; 195 (6) 1564-1570