Download PDF
Z Geburtshilfe Neonatol 2015; 219(01): 22-27
DOI: 10.1055/s-0034-1382002
Review
© Georg Thieme Verlag KG Stuttgart · New York

Management of Complicated Monochorionic Twin Pregnancies

Management komplizierter monochorialer Zwillingsschwangerschaften
J. Degenhardt
1   Department of OB/GYN, Division of Prenatal Medicine, Justus-Liebig University and UKGM, Campus Giessen, Giessen, Germany
,
C. Enzensberger
2   Department of OB/GYN, Division of Prenatal Medicine, UKGM, Campus Marburg, Marburg, Germany
,
A. Tenzer
1   Department of OB/GYN, Division of Prenatal Medicine, Justus-Liebig University and UKGM, Campus Giessen, Giessen, Germany
,
A. Kawecki
1   Department of OB/GYN, Division of Prenatal Medicine, Justus-Liebig University and UKGM, Campus Giessen, Giessen, Germany
,
T Kohl
3   German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), Justus-Liebig University, Giessen, Germany
,
R. Axt-Fliedner
1   Department of OB/GYN, Division of Prenatal Medicine, Justus-Liebig University and UKGM, Campus Giessen, Giessen, Germany
2   Department of OB/GYN, Division of Prenatal Medicine, UKGM, Campus Marburg, Marburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 March 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Multiple gestation is associated with an increased risk for adverse pregnancy outcome. Monochorionic twins are at risk for complications specific to these pregnancies, such as twin-twin transfusion syndrome (TTTS) or twin reverse arterial perfusion (TRAP) sequence. In this article we give an overview on prenatal diagnosis, treatment and outcome of twin pregnancies complicated by TTTS and TRAP sequence.

Zusammenfassung

Mehrlingsschwangerschaften im allgemeinen gehen mit einem erhöhten Risiko prä- und perinataler Komplikationen einher. Bei monochoria­len Zwillingen besteht darüber hinaus das Risiko für die Entwicklung spezifischer Probleme wie eines feto-fetalen Transfusionssyndroms (FFTS) oder der Twin-Reverse-Arterial-Perfusion (TRAP) –Sequenz.

Im vorliegenden Artikel geben wir einen Überblick über pränatale Diagnose, Behandlungsmöglichkeiten und postnatales Outcome von monochorialen Zwillingen mit FFTS oder TRAP-Sequenz.

Key words

Monochorionic twins - twin-to-twin transfusion syndrome - TRAP

Schlüsselwörter

Monochoriale Zwillinge - feto-fetales Transfusions­syndrom - TRAP
 

  • References

  • 1 Berghella V, Kaufmann M. Natural history of twin-twin transfusion syndrome. J Reprod Med 2001; 46: 480-483
    PubMedGoogle Scholar
  • 2 Lewi L, Jani J, Blickstein I et al. The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. Am J Obstet Gynecol 2008; 199: 514-518
    PubMedGoogle Scholar
  • 3 De Paepe ME, Shapiro S, Greco D et al. Placental markers of twin-to-twin transfusion syndrome in diamniotic-monochorionic twins: a morphometric analysis of deep artery-to-vein anastomoses. Placenta 2010; 31: 269-276
    CrossrefPubMedGoogle Scholar
  • 4 Denbow ML, Cox P, Taylor M et al. Placental angioarchitecture in monochorionic twin pregnancies: relationship to fetal growth, fetofetal transfusion syndrome and pregnancy outcome. Am J Obstet Gynecol 2000; 182: 417-426
    CrossrefPubMedGoogle Scholar
  • 5 Mahieu-Caputo D, Dommergues M, Delezoide AL et al. Twin-to-twin transfusion syndrome. Role of the fetal renin-angiotensin system. Am J Pathol 2000; 156: 629
    CrossrefPubMedGoogle Scholar
  • 6 Bajoria R, Ward S, Chatterjee R. Natriuretic peptides in the pathogenesis of cardiac dysfunction in the recipient fetus of twin-twin transfusion syndrome. Am J Obstet Gynecol 2002; 186: 121
    CrossrefPubMedGoogle Scholar
  • 7 Karatza AA, Wolfenden JL, Taylor MJ et al. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart 2002; 88: 271
    CrossrefPubMedGoogle Scholar
  • 8 Simpson LL, Marx GR, Elkadry EA et al. Cardiac dysfunction in twin-twin transfusion syndrome: a prospective, longitudinal study. Obstet Gynecol 1998; 92: 557
    CrossrefPubMedGoogle Scholar
  • 9 Barrea C, Alkazaleh F, Ryan G et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol 2005; 192: 892
    CrossrefPubMedGoogle Scholar
  • 10 Quintero RA, Morales WJ, Allen MH et al. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19: 550
    CrossrefPubMedGoogle Scholar
  • 11 Lewi L, Jani J, Boes AS et al. The natural history of monochorionic twins and the role of prenatal ultrasound scan. Ultrasound Obstet Gynecol 2007; 30: 401
    PubMedGoogle Scholar
  • 12 Lewi L, Lewi P, Diemert A et al. The role of ultra-sound examination in the first trimester and at 16 weeks’ gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. Am J Obstet Gynecol 2008; 199: e1-e7
    PubMedGoogle Scholar
  • 13 Dickinson JE, Evans S. The progression of disease stage in twin–twin transfusion syndrome. J Matern Fetal Neonatal Med 2004; 16: 95-101
    CrossrefPubMedGoogle Scholar
  • 14 Wagner MM, Lopriore E, Klumper FJ et al. Short- and long-term outcome in stage 1 twin-to-twin transfusion syndrome treated with laser surgery compared with conservative management. Am J Obstet Gynecol 2009; 201: 286 e1
    CrossrefPubMedGoogle Scholar
  • 15 Middeldorp JM, Sueters M, Lopriore E et al. Fetoscopic laser surgery in 100 pregnancies with severe twin-to-twin transfusion syndrome in the Netherlands. Fetal Diagn Ther 2007; 22: 190-194
    CrossrefPubMedGoogle Scholar
  • 16 Roberts D, Gates S, Kilby M et al. Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol 2008; 31: 701-711
    CrossrefPubMedGoogle Scholar
  • 17 Rossi C, D’Addario V. Survival outcomes of twin-twin transfusion syndrome in stage I: a systematic review of the literature. Am J Perinatol 2013 Jan 30: 5-10
    PubMedGoogle Scholar
  • 18 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: 1046
    PubMedGoogle Scholar
  • 19 Senat MV, Deprest J, Boulvain M et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004; 351: 136
    CrossrefPubMedGoogle Scholar
  • 20 Rossi AC, D’Addario V. Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol 2008; 198: 147
    CrossrefPubMedGoogle Scholar
  • 21 Quintero RA, Comas C, Bornick PW et al. Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2000; 16: 230
    CrossrefPubMedGoogle Scholar
  • 22 Quintero RA, Ishii K, Chmait RH et al. Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med 2007; 20: 763-768
    CrossrefPubMedGoogle Scholar
  • 23 Chmait RH, Kontopoulos EV, Korst LM et al. Stage-based outcomes of 682 consecutive cases of twin-twin transfusion syndrome treated with laser surgery: the USFetus experience. Am J Obstet Gynecol 2011; 204: 393 e1
    CrossrefPubMedGoogle Scholar
  • 24 Slaghekke F, Lopriore E, Lewi L et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet 2014; pii S0140-6736(13)62419-8 DOI: 10.1016/S0140-6736(13)62419-8. [Epub ahead of print]
    PubMedGoogle Scholar
  • 25 Lopriore E, Slaghekke F, Middeldorp JM et al. Residual anastomoses in twin-to-twin transfusion syndrome treated with selective fetoscopic laser surgery: localization, size, and consequences. Am J Obstet Gynecol 2009; 201: 66 e1
    CrossrefPubMedGoogle Scholar
  • 26 Slaghekke F, Kist WJ, Oepkes D et al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal Diagn Ther 2010; 27: 181
    CrossrefPubMedGoogle Scholar
  • 27 Lopriore E, Hecher K, Vandenbussche FP et al. Fetoscopic laser treatment of twin-to-twin transfusion syndrome followed by severe twin anemia-polycythemia sequence with spontaneous resolution. Am J Obstet Gynecol 2008; 199: 493 e1-493 e7
    CrossrefPubMedGoogle Scholar
  • 28 Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990; 163: 907-912
    CrossrefPubMedGoogle Scholar
  • 29 Van Allen MI, Smith DW, Shepard TH. Twin reversed arterial perfusion (TRAP) sequence: a study of 14 twin pregnancies with acardius. Semin Perinatol 1983; 7: 285
    PubMedGoogle Scholar
  • 30 Van Gemert MJC, Umur A, van den Wijngaard JPHM et al. Increasing cardiac output and decreasing oxygenation sequence in pump twins of acardiac twin pregnancies. Phys Med Biol 2005; 50: N33-42
    CrossrefPubMedGoogle Scholar
  • 31 Moore TR, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990; 163: 907
    CrossrefPubMedGoogle Scholar
  • 32 Lewi L, Valencia C, Gonzalez E et al. The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol 2010; 203 (213) e1-e4
    CrossrefPubMedGoogle Scholar
  • 33 Ville Y, Hyett JA, Vandenbussche FP et al. Endoscopic laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol 1994; 4: 396
    CrossrefPubMedGoogle Scholar
  • 34 Lee H, Wagner AJ, Sy E et al. Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. Am J Obstet Gynecol 2007; 197: 459
    PubMedGoogle Scholar
  • 35 Deprest JA, Audibert F, Van Schoubroeck D et al. Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy. Am J Obstet Gynecol 2006; 28: 688
    PubMedGoogle Scholar
  • 36 Jolly M, Taylor M, Rose G et al. Interstitial laser: a new surgical technique for twin reversed arterial perfusion sequence in early pregnancy. BJOG 2001; 108: 1098-1102
    PubMedGoogle Scholar
  • 37 Pagani G, D’Antonio F, Khalil A et al. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2013; 42: 6
    CrossrefPubMedGoogle Scholar
  • 38 Cabassa P, Fichera A, Prefumo F et al. The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature. Eur J Obstet Gynecol Reprod Biol 2013; 166: 127
    CrossrefPubMedGoogle Scholar
  • 39 Diehl W, Glosemeyer P, Tavares De Sousa M et al. Twin anemia-polycythemia sequence in a case of monoamniotic twins. Ultrasound ­Obstet Gynecol 2013; 42: 108-111
    PubMedGoogle Scholar
  • 40 Gardiner HM, Matsui H, Roughton M et al. Cardiac function in 10-year-old twins following differetn fetal therapies for twin-twin transfusion syndrome. Ultrasound Obestet Gynecol 2014; 43: 652-657
    PubMedGoogle Scholar