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Chapter 11.5 - Twin-to-twin transfusion syndrome

management of stage I disease

from Section 2 - Fetal disease

Published online by Cambridge University Press:  05 February 2013

By
Ramesha Papanna  and
Kenneth J. Moise Jr.
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
Department of Fetal Medicine, University of Birmingham
Anthony Johnson
Affiliation:
Baylor College of Medicine, Texas
Dick Oepkes
Affiliation:
Department of Obstetrics, Leiden University Medical Center
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Summary

Natural history of stage I disease

Twin-to-twin transfusion syndrome (TTTS) is a complication that affects approximately 10% of all monochorionic twin pregnancies. When the process begins in the second trimester and is left untreated, over 80% of affected pregnancies will end with the death of one or both fetuses, or with one fetus surviving with neurological deficit [1]. TTTS is classified based on the ultrasound findings [2]. Stage I is diagnosed when there is fluid discrepancy between the two fetuses with a donor sac with maximum vertical pocket (MVP) ≤2 cm and the recipient sac MVP of ≥8 cm; a visible donor bladder; and with normal Doppler flow studies in umbilical artery, umbilical vein, or ductus venosus of both fetuses. In European centers, after 20 weeks’ gestation the criteria for stage I diagnosis is recipient’s MVP of ≥10 cm. Stage II disease includes the findings of stage I along with an absent or non-cycling small donor bladder. Stage III disease is presence of abnormal Doppler flow studies in umbilical artery, umbilical vein, or ductus venosus in either fetus. Stage IV is when there is fetal hydrops in one of the fetuses. Stage V is when at least one of the fetuses is in demise. TTTS does not follow a sequential progression through the different stages of disease as it may skip stages within a defined time frame.

Keywords

polyhydramniosstage I diseasetwin-to-twin transfusion syndromeNorth American Fetal Therapy Networkamnioreductionmonochorionic twin pregnancy
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 184 - 186
Publisher: Cambridge University Press
Print publication year: 2012

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References

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