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Chapter 11.4 - Twin-to-twin transfusion syndrome

treatment by fetoscopic laser ablation

from Section 2 - Fetal disease

Published online by Cambridge University Press:  05 February 2013

By
Gihad E. Chalouhi ,
Abdullah Al Ibrahim ,
Mohammed Essaoui  and
Yves Ville
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

Introduction

Monochorionic twin placentation occurs in 20% of spontaneous twin pregnancies and almost 5% of those are obtained by medically assisted reproduction [1]. Monochorionic diamniotic (McDa) twin fetuses have the unique characteristic of living upon one single placenta. This situation can lead to specific complications including twin-to-twin transfusion syndrome (TTTS) [2, 3], twin-anemia-polycythemia sequence (TAPS) [4, 5], and selective intrauterine growth retardation (s-IUGR) [6]. These complications are likely to explain most of the 6- to 12-fold increase in perinatal mortality in monochorionic twins compared to dichorionic twins [7–10].

TTTS, also called twin oligohydramnios-polyhydramnios sequence (TOPS), complicates around 15% of monochorionic pregnancies irrespective of the mode of conception [7]. It is a hemodynamic, and probably hormonal, discordance secondary to imbalanced blood flows through the vascular anastomoses aforementioned [11–14]. The natural history of untreated TTTS leads to intra- or perinatal death in as many as 90% of cases [15, 16]. Impaired neurological development is reported in up to 50% of survivor-twins as a consequence of prematurity or of the intrauterine fetal demise (IUFD) of the co-twin [17, 18]. It is hence crucial to diagnose and treat TTTS as early as possible and using the best-proven management strategy. In this chapter, we will mainly discuss its treatment options focusing on fetoscopic laser ablation of anastomoses. We will also discuss the benefits and risks associated with this treatment.

Keywords

twin-to-twin transfusion syndromelaser treatmentmaternal morbidityseptostomyfetoscopic laser coagulationamnioreductionanesthesia
Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 173 - 183
Publisher: Cambridge University Press
Print publication year: 2012

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